Feasibility and Safety of Utilising Epidural Anesthesia Without Endotracheal Intubation for Pancreaticoduodenectomy in a High-Income Developing Nation

Background: There is some evidence to suggest that general anaesthesia may influence oncological outcomes, such as survival and disease-free recurrence, in addition to surgical outcomes. This study compares clinico-oncological outcomes of pancreatic cancer patients who had pylorus-preserved pancreaticoduodenectomy (PPPD) under epidural anaesthesia without endotracheal intubation (EA) and those who received general anaesthesia (GA). Methods: A retrospective cohort investigation of a prospective maintained database comparing pancreatic cancer patients with PPPD under GA and EA. The procedure's feasibility and 30-day clinical-pathological outcomes were evaluated between groups. Results: The ratio of males to females was 16:5. The mean age was 51 years (range 27–74 years). The median hospital stay was 12 days (range 7–60). In the GA group, 13 patients had PPPD, and one patient received total pancreatectomy with splenectomy (TPS). On the other hand, in the EA group, six patients received PPPD, and two patients underwent TPS. The two groups had similar preoperative demographics, including ASA classification. Seven EA patients underwent successful surgery without GA conversion. Due to respiratory acidosis, one TPS patient was converted to GA before abdominal closure. Neither group had mortality or major cardiopulmonary issues, with the exception of one case in the GA group who acquired COVID-19 while hospitalised and was ventilated for 10 days until completely recovering. Surgical complications occurred as follows: Two GA patients had pancreatic fistula type B, and one EA patient had a biliary leak, all treated conservatively. One GA patient needed a revision laparoscopy after an iatrogenic bowel Perforation during IR-drain insertion for chylous ascites on postoperative day 30. All cases had an R0 resection. The histological tumour stage was similar in both groups. The EA group has significantly more harvested lymph nodes and a higher number of lymph node metastases (p=0.022 and p=0.005, respectively). Conclusions: Pancreaticoduodenectomy with just epidural anaesthesia and without endotracheal intubation can be performed safely in selected cases. It may decrease surgical complications without affecting oncological outcomes. Additional research is necessary to comprehend its actual advantages. Portions of the data reported herein were previously shared as an oral presentation at the International Surgical Week in Kuala Lumpur, August 2024