Propofol-based total intravenous anaesthesia is associated with better survival than desflurane anaesthesia in hepatectomy for hepatocellular carcinoma: a retrospective cohort study

Abstract

Background: Previous studies have shown that anaesthetic technique can affect outcomes of cancer surgery. We investigated the association between anaesthetic technique and patient outcomes after elective hepatectomy for hepatocellular carcinoma. Methods: This was a retrospective single-centre cohort study of patients who received elective hepatectomy for hepatocellular carcinoma from January 2005 to December 2014. Patients were grouped according to propofol or desflurane anaesthesia. KaplaneMeier analysis was performed and survival curves were constructed from the date of surgery to death. After propensity matching, univariable and multivariable Cox regression models were used to compare hazard ratios for death. Subgroup analyses were performed for tumourenodeemetastasis staging and distant metastasis and local recurrence. Results: A total of 492 patients (369 deaths, 75.0%) with desflurane anaesthesia and 452 (139 deaths, 30.8%) with propofol anaesthesia were eligible for analysis. After propensity matching, 335 patients remained in each group. In the matched analysis, propofol anaesthesia had a better survival with hazard ratio of 0.47 (95% confidence interval, 0.38e0.59; P<0.001). Subgroup analyses also showed significantly better survival in the absence of distant metastasis (hazard ratio, 0.47; 95% confidence interval, 0.37e0.60; P<0.001) or local recurrence (hazard ratio, 0.22; 95% confidence interval, 0.14e0.34; P<0.001) in the matched groups. Conclusions: Propofol anaesthesia was associated with better survival in hepatocellular carcinoma patients who underwent hepatectomy. Prospective studies are warranted to evaluate the effects of propofol anaesthesia on surgical outcomes in hepatocellular carcinoma patients.

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“…Apart from its anesthetic effects, propofol also exerts a number of non-anesthetic effects, such as reduction of oxidative damage [37], decreases proinflammatory cytokines [38], inhibits COX-2 and PGE 2 functions and decrease surgery-induced neuroendocrine responses and cause less immunosuppression and recurrence of certain types of cancer [39,40]. In vitro and in vivo, propofol could inhibit invasion, migration, metastasis and induced apoptosis and cell cycle arrest of numerous cancer cells [12][13][14][15][16][17][18].…”

Propofol-based total intravenous anesthesia is associated with better survival than desflurane anesthesia in robot-assisted radical prostatectomy

“…The results were consistent with our previous reports demonstrating that propofol anesthesia was related to better survival and a lower incidence of postoperative recurrence or metastasis compared with desflurane anesthesia in colon cancer, hepatocellular carcinoma, and intrahepatic cholangiocarcinoma surgery. [15,16,20,21] By contrast, there were retrospective studies reporting insignificant differences in overall survival between the use propofol and VAs in surgery for breast cancer, lung cancer. [11,22,23] To our best knowledge, there are very few researches of the effects of the propofol and VAs in patients undergoing prostate cancer surgery, and further investigations are needed.…”

“…Repetitive bolus injections of fentanyl and cisatracurium or rocuronium were used as needed during surgery. [15,16] Desflurane or maintenance of the effect-site concentration with target-controlled infusion using propofol was adjusted downward and upward by 0.5-2% or 0.2-0.5 μg/mL, respectively, when needed based on the hemodynamics. The level of end-tidal carbon dioxide was kept at 35-45 mmHg by adjusting the ventilation rate with volume control model with tidal volume 6-8 mg/kg and kept a maximum airway pressure < 30 cm H 2 O.…”

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

“…50 Similarly, a retrospective cohort study uncovered that patients in desflurane anesthesia group had a worse outcome, such as higher mortality rate (75.0% versus 30.8%), distant metastasis (15.9% versus 5.5%) or a higher local recurrence (70.1% versus 37.8%), compared with propofol group in HCC patients who underwent hepatectomy during 10 years' follow-up. 51 In contrast, a clinical research found that epithelial ovarian cancer patients at stage III who were given desflurane were related to a less overall rate of recurrence during primary cytoreductive surgery compared with patients who were given sevoflurane. 52 But the Kaplan-Meier curves demonstrated that PFS and OS rates at 1 and 5 years were similar for patients given desflurane in comparison with isoflurane during the glioblastoma surgery.…”