Impact of Anesthesia on Long-term Outcomes in Patients With Supratentorial High-grade Glioma Undergoing Tumor Resection: A Retrospective Cohort Study

Abstract

Background: Intravenous and inhalational anesthesia might have different associations with long-term outcome in cancer patients, with reports of adverse effects of inhalation anesthesia. However, the effects of anesthesia in patients with high-grade glioma (HGG) are not known. Methods: This study investigated 154 patients who received propofol and 140 patients who received sevoflurane for maintenance of anesthesia during HGG tumor resection. The primary outcomes were progression-free survival and overall survival. Results: Median progression-free survival was 10 months (interquartile range [IQR], 6 to 18) versus 11 months (IQR 6 to 20; P=0.674), and median overall survival was 18 months (IQR, 11 to 39) versus 18 months (IQR, 10 to 44; P=0.759) in patients maintained with propofol and sevoflurane, respectively. Higher preoperative Karnofsky performance status and postoperative chemotherapy were associated with a reduced hazard of tumor progression or death, whereas higher age-adjusted Charlson comorbidity index and longer duration of anesthesia were associated with an increased hazard of progression or death. World Health Organization tumor classification IV and incomplete tumor resection were associated with an increased hazard of tumor progression but not death. Anesthesia maintenance with sevoflurane increased the risk of death in patients with Karnofsky performance status <80 compared with propofol (hazard ratio, 1.66; 95% confidence interval, 1.08-2.57; P=0.022). Conclusions: Compared with maintenance of anesthesia with propofol, sevoflurane did not worsen progression-free or overall survival in patients with HGG undergoing tumor resection. However, propofol might be beneficial in patients with poor preoperative Karnofsky performance status.

The choice of anaesthesia for glioblastoma surgery does not impact the time to recurrence

“…One might criticize the cohort size as being too small to reveal smaller effects; however, the completely identical course until progression, even when potentially calculated for larger cohorts, would make a clinically relevant effect highly improbable. Our observation is in line with a recent retrospective analysis comparing high-grade glioma patients receiving propofol or sevoflurane for maintainance which also showed no significant difference in progression free or overall survival 16 . However, a standardized therapy for glioblastomas is only defined for primary treatment.…”

Effects of propofol on the development of cancer in humans

“…13 Recently, one study found that in patients with high-grade glioma undergoing cancer surgery, intraoperative use of propofol or sevoflurane anaesthesia led to no difference in OS or progression-free survival (PFS). 14 In the study by Oh et al, 15 among patients who underwent gastric cancer surgery, there was no difference in cancer-related mortality after using propofol or inhalation anaesthesia. Nonetheless, these findings are retrospective and have some important limitations.…”

<p>The Role of Inhaled Anesthetics in Tumorigenesis and Tumor Immunity</p>

“…8,9 Furthermore, compared with the propofol group, the sevoflurane group displayed a higher rate of cancer recurrence in breast cancer patients undergoing modified radical mastectomy, 10 and increased the risk of death in patients with high-grade glioma undergoing tumor resection. 11 But recently, a randomized control trial involved in more than 2000 women who underwent breast cancer surgery demonstrated that there was no significant difference in breast cancer recurrence rate among women receiving general anesthesia (sevoflurane and opioids) and regional anesthesia analgesia (paravertebral block and propofol). 12 Therefore, according to published reports, compared with propofol, sevoflurane might have no effect on the prognosis of breast cancer patients during the surgery, but it could have an unfavorable effect on the outcomes of patients with other cancers, which need further investigation.…”