Long-Term Oncologic Outcomes for Patients Undergoing Volatile Versus Intravenous Anesthesia for Non-Small Cell Lung Cancer Surgery

Abstract

Propofol-based total intravenous anesthesia (TIVA) has been reported to improve long-term outcome following cancer surgery, when compared with inhalation agents. However, such investigational reports are still controversial, and no studies have been conducted in relation to non-small cell lung cancer (NSCLC) surgery. The present study aimed to compare the favorable effects of TIVA versus inhalation agents on recurrence-free survival and overall survival after curative resection of NSCLC. This retrospective cohort study examined medical records of the patients who were diagnosed with NSCLC and underwent curative resection at Seoul National University Bundang Hospital from August 2003 to July 2012. The primary outcome included the comparison of postoperative overall survival and recurrence-free survival in both groups. To balance the 2 groups for analysis, a propensity matching method was used, and stratified Cox proportional hazard models were used for statistical analysis. This study included 943 cases of NSCLC for final analysis, and the cases were divided into the TIVA group (n = 749) and inhalation group (n = 194). Propensity matching produced 196 patients in each group. The final analysis revealed no significant difference in the hazard ratio (HR) for recurrence between the TIVA and inhalation groups (P = .233). The HR for death between the 2 groups was not significantly different either (P = .551). In this study, we found no benefit of propofol-based TIVA for long-term oncologic outcome after NSCLC surgery, relative to inhalation agents.

Anesthetic technique and cancer outcomes: a meta-analysis of total intravenous versus volatile anesthesia

“…All studies except Yan et al 19 adjusted for at least one of the following variables in their multivariate analyses: age, body mass index, comorbidities, preoperative therapy, pathologic stage or grade of cancer, and intraoperative anesthetic interventions such as epidural or blood transfusion. [12][13][14][15][16][17][18]20,21…”

“…Oh et al (16) defined recurrence-free survival as the period from surgery date to the date of recurrence or death.…”

“…All the nine retrospective studies had a NOS C 7 demonstrating good methodologic quality and a low risk of bias. [12][13][14][15][16][17][18]20,21 The single prospective RCT included in this meta-analysis had a low risk of bias for each domain. 19…”

“…Six studies (five retrospective [13][14][15][16]20 and one RCT) 19 examined the effects of TIVA and volatile agents on recurrence-free survival in breast, esophageal, and nonsmall cell lung cancer (Fig. 2).…”

“…Eight studies (seven retrospective 12,13,[16][17][18]20,21 and one RCT), 19 that included a total of 18,778 patients, provided ten HRs for this analysis (Fig. 3) in breast, colorectal, gastric, esophageal, and non-small cell lung cancer, and mixed cancer types.…”