Long-term survival in older patients given propofol or sevoflurane anaesthesia for major cancer surgery: follow-up of a multicentre randomised trial

Cao, Shuang-Jie; Zhang, Yue; Zhang, Yuxiu; Zhao, Wei; Pan, Linghui; Sun, Xude; Jia, Zhen; Ouyang, Wen; Ye, Qing-Shan; Zhang, Fangxiang; Guo, Yongqing; Ai, Yanqiu; Zhao, Bin-Jiang; Yu, Jianbo; Liu, Zhiheng; Yin, Ning; Li, Xueying; Ma, Jiahui; Li, Huijuan; Wang, Meirong; Sessler, Daniel I.; Ma, Ding; Wang, Dong‐Xin

doi:10.1016/j.bja.2023.01.023

Cited by 17 publications

(12 citation statements)

References 41 publications

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“…Forty-two retrospective cohort studies and two RCTs with a total of 686,923 patients were included in this study [ [19] , [20] , [21] , [22] , [23] , [24] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] ]. Thirty-five trials were single-center studies [ 19 , [21] , [22] , [23] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [50] , [51] , …”

Section: Resultsmentioning

confidence: 99%

“…Types of cancer surgery and inhalation anesthetics varied between studies. In total, two studies enrolled participants undergoing surgery for glioblastoma [ 47 , 56 ], one study for oral cancer [ 63 ], nine studies for breast cancer [ 34 , 37 , 42 , 45 , 49 , 53 , 59 , 61 , 71 ], five studies for non-small cell lung cancer [ 38 , 55 , 60 , 65 , 69 ], two studies for esophageal cancer [ 36 , 68 ], four studies for gastric cancer [ 40 , 44 , 50 , 57 ], five studies for colorectal cancer [ 34 , 39 , 48 , 54 , 62 ], four studies for hepatobiliary cancer [ 19 , 41 , 43 , 51 ], two studies for pancreatic cancer [ 52 , 64 ], two studies for gynecological cancer [ 21 , 22 ], two studies for urological cancer [ 23 , 58 ], one study for osteosarcoma [ 66 ], and six studies for various cancers [ 20 , 24 , 35 , 46 , 68 , 70 ]. For inhalation anesthetics, seventeen studies used sevoflurane to maintain anesthesia [ 19 , 21 , 34 , 38 , 40 , [47] , [48] , [49] , 53 , 59 , [62] , [63] , [64] , …”

Section: Resultsmentioning

confidence: 99%

“…For inhalation anesthetics, seventeen studies used sevoflurane to maintain anesthesia [ 19 , 21 , 34 , 38 , 40 , [47] , [48] , [49] , 53 , 59 , [62] , [63] , [64] , [65] , 67 , 70 , 71 ], nine studies used desflurane [ 22 , 39 , [41] , [42] , [43] , 50 , 52 , 56 , 66 ] and eighteen studies administered various inhalation anesthetics [ 20 , 23 , 24 , [35] , [36] , [37] , [44] , [45] , [46] , 51 , 54 , 55 , 57 , 58 , 60 , 61 , 68 , 69 ]. Twenty-six studies included elective surgery [ 19 , 21 , 22 , 36 , [38] , [39] , [40] , [41] , 43 , 44 , [46] , [47] , [48] , [50] , [51] , [52] , [53] , 56 , 60 , [62] , [63] , …”

Section: Resultsmentioning

confidence: 99%

“…Forty studies reported OS [ 19 , 20 , [22] , [23] , [24] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , 52 , [54] , [55] , [56] , [57] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] ]. When compared with inhalation anesthesia, propofol-based anesthesia was associated with better OS (HR = 0.82, 95 % CI:0.76–0.88, P < 0.00001, I 2 = 82 %) ( Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Nine multicenter studies [ 20 , 24 , 49 , 54 , 59 , 61 , 68 , 70 , 71 ] and thirty-one single-center studies [ 19 , 22 , 23 , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , 50 , 52 , [55] , [56] , [57] , 60 , [62] , [63] , [64] , [65] , [66] , [67] , 69 ] reported on OS. Multicenter studies indicated that propofol-based anesthesia had no advantage in OS compared with inhalation anesthesia (HR = 0.98, 95 % CI:0.94–1.03, P = 0.51, I 2 = 56 %).…”

Section: Resultsmentioning

confidence: 99%

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GABA (γ-aminobutyric acid) receptors are constituents of many inhibitory synapses within the central nervous system. They are formed by 5 subunits out of 19 various subunits: α1-6, β1-3, γ1-3, δ, ε, θ, π, and ρ1-3. Two main subtypes of GABA receptors have been identified, namely GABAA and GABAB. The GABAA receptor (GABAAR) is formed by a variety of combinations of five subunits, although both α and β subunits must be included to produce a GABA-gated ion channel. Other subunits are γ, δ, ε, π, and ϴ. GABAAR has many isoforms, that dictate, among other properties, their differing affinities and conductance. Drugs acting on GABAAR form the cornerstone of anesthesia and sedation practice. Some such GABAAR agonists used in anesthesia practice are propofol, etomidate, methohexital, thiopental, isoflurane, sevoflurane, and desflurane. Ketamine, nitrous oxide, and xenon are not GABAR agonists and instead inhibit glutamate receptors-mainly NMDA receptors. Inspite of its many drawbacks such as pain in injection, quick and uncontrolled conversion from sedation to general anesthesia and dose-related cardiovascular depression, propofol remains the most popular GABAR agonist employed by anesthesia providers. In addition, being formulated in a lipid emulsion, contamination and bacterial growth is possible. Literature is rife with newer propofol formulations, aiming to address many of these drawbacks, and with some degree of success. A nonemulsion propofol formulation has been developed with cyclodextrins, which form inclusion complexes with drugs having lipophilic properties while maintaining aqueous solubility. Inhalational anesthetics are also GABA agonists. The binding sites are primarily located within α + /β − and β + /α − subunit interfaces, with residues in the α + /γ − interface. Isoflurane and sevoflurane might have slightly different binding sites providing unexpected degree of selectivity. Methoxyflurane has made a comeback in Europe for rapid provision of analgesia in the emergency departments. Penthrox (Galen, UK) is the special device designed for its administration. With better understanding of pharmacology of GABAAR agonists, newer sedative agents have been developed, which utilize "soft pharmacology," a term pertaining to agents that are rapidly metabolized into inactive metabolites after producing desired therapeutic effect(s). These newer "soft" GABAAR agonists have many properties of ideal sedative agents, as they can offer well-controlled, titratable activity and ultrashort action. Remimazolam, a modified midazolam and methoxycarbonyl-etomidate (MOC-etomidate), an ultrashort-acting etomidate analog are two such examples. Cyclopropyl methoxycarbonyl metomidate is another second-generation soft etomidate analog that has a greater potency and longer half-life than MOC-etomidate. Additionally, it might not cause adrenal axis suppression. Carboetomidate is another soft analog of etomidate with low affinity for 11β-hydroxylase and is, therefore, unlikely to have clinically significant adrenocortical suppressant e...

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Long-term survival in older patients given propofol or sevoflurane anaesthesia for major cancer surgery: follow-up of a multicentre randomised trial

Cited by 17 publications

References 41 publications

Effects of anesthesia on long-term survival in cancer surgery: A systematic review and meta-analysis

Effects of anesthesia on long-term survival in cancer surgery: A systematic review and meta-analysis

Anesthetic Techniques and Long-Term Oncological Outcomes

The Role of GABA Receptors in Anesthesia and Sedation: An Updated Review

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