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. 2019 May;98(18):e15442.
doi: 10.1097/MD.0000000000015442.

Does postoperative morphine consumption for acute surgical pain impact oncologic outcomes after colorectal cancer resection?: A retrospective cohort study

Hsiang-Ling Wu  1   2 , Ying-Hsuan Tai  1   2   3   4 , Wen-Kuei Chang  1   2   5 , Kuang-Yi Chang  1   2 , Mei-Yung Tsou  1   2 , Yih-Giun Cherng  3   4 , Shih-Pin Lin  1   2
Affiliations

Does postoperative morphine consumption for acute surgical pain impact oncologic outcomes after colorectal cancer resection?: A retrospective cohort study

Hsiang-Ling Wu et al. Medicine (Baltimore). 2019 May.

Abstract

Whether morphine used in human cancer surgery would exert tumor-promoting effects is unclear. This study aimed to investigate the effects of morphine dose on cancer prognosis after colorectal cancer (CRC) resection.In a retrospective study, 1248 patients with stage I through IV CRC undergoing primary tumor resections and using intravenous patient-controlled analgesia for acute surgical pain at a tertiary center between October 2005 and December 2014 were evaluated through August 2016. Progression-free survival (PFS) and overall survival (OS) were analyzed using proportional hazards regression models.Multivariable analysis demonstrated no dose-dependent association between the amount of morphine dose and PFS (adjusted hazard ratio, HR = 1.31, 95% confidence interval, CI = 0.85-2.03) or OS (adjusted HR = 0.86, 95% CI = 0.47-1.55). Patients were further classified into the high-dose and low-dose groups by the median of morphine consumption (49.7 mg), and the morphine doses were mean 75.5 ± standard deviation 28.8 mg and 30.1 ± 12.4 mg in high-dose and low-dose groups, respectively. Multivariable models showed no significant difference in PFS or OS between groups, either (adjusted HR = 1.24, 95% CI = 0.97-1.58 for PFS; adjusted HR = 1.01, 95% CI = 0.71-1.43 for OS).Our results did not support a definite association between postoperative morphine consumption and cancer progression or all-cause mortality in patients following CRC resection.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Kaplan–Meier curves for progression-free survival of the two groups. Significantly better progression-free survival after surgery was found for colorectal cancer in low-dose groups compared with high-dose group in all patients (P = .028 by log-rank test) (A) but not stage-stratified subgroups (B) in univariate analysis (stage I: P = .107, stage II: P = .639, stage III: P = .590, stage IV: P = .529; all by log-rank tests).
Figure 2
Figure 2
Kaplan–Meier curves for overall survival of the two groups. No significant difference of overall survival after surgery was found for colorectal cancer when comparing high-dose with low-dose groups in univariate analysis, except for stage II disease (all patients: P = .583, stage I: P = .517, stage II: P = .014, stage III: P = .672, stage IV: P = .291; all by log-rank tests).
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