Propofol-based Total Intravenous Anesthesia Is Associated with Better Survival Than Desflurane Anesthesia in Colon Cancer Surgery

Abstract

Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Previous research has shown different effects of anesthetics on cancer cell growth. Here, the authors investigated the association between type of anesthetic and patient survival after elective colon cancer surgery. Methods A retrospective cohort study included patients who received elective colon cancer surgery between January 2005 and December 2014. Patients were grouped according to anesthesia received: propofol or desflurane. After exclusion of those who received combined propofol anesthesia with inhalation anesthesia or epidural anesthesia, 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 tumor–node–metastasis staging and postoperative metastasis. Results A total of 706 patients (307 deaths, 43.5%) with desflurane anesthesia and 657 (88 deaths, 13.4%) with propofol anesthesia were eligible for analysis. After propensity matching, 579 patients remained in each group (189 deaths, 32.6%, in the desflurane group vs. 87, 15.0%, in the propofol group). In the matched analyses, the propofol-treated group had a better survival, irrespective of lower tumor–node–metastasis stage (hazard ratio, 0.22; 95% CI, 0.11 to 0.42; P < 0.001) or higher tumor–node–metastasis stage (hazard ratio, 0.42; 95% CI, 0.32 to 0.55; P < 0.001) and presence of metastases (hazard ratio, 0.67; 95% CI, 0.51 to 0.86; P = 0.002) or absence of metastases (hazard ratio, 0.08; 95% CI, 0.01 to 0.62; P = 0.016). Simple propensity score adjustment produced similar findings. Conclusions Propofol anesthesia for colon cancer surgery is associated with better survival irrespective of tumor–node–metastasis stage.

An assessment of the survival impact of multimodal anesthesia/analgesia technique in adults undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a propensity score matched analysis

“…Furthermore, although the MA technique was associated with a significant reduction in postoperative inflammatory markers, our results do not support our hypothesis that combining several anesthetics/analgesics with anti-tumor properties would be associated with improved survival. Our findings are also not consistent with those of other studies which have demonstrated a favorable association between opioid-sparing TIVA and cancer progression [14,16]. Among several other factors, the differences in our findings may be explained by the components of MA in our study, the aggressive nature of appendiceal carcinomatosis, or the slightly older and sicker demographic of our MA group.…”

“…This may have been evidenced by the significantly higher risk of progression and death in the MA group in unadjusted models, which remained higher (although insignificant) in the adjusted models; perhaps an effect of our small sample size. That said, a somewhat similar observation could be made about the studies by Wigmore et al [14] and Wu et al [16]. In both studies, patients who received volatile-opioid anesthesia had higher ASA scores and more advanced disease, and demonstrated worse survival after PSM.…”

“…In a large retrospective study by Wigmore et al [14], patients who received volatile anesthesia while undergoing oncologic surgery had a 46% increased risk of death compared to those who received propofol-based TIVA. In a smaller group of patients undergoing colon cancer surgery, Wu et al [16] reported a 64% reduction in the risk of death of patients who received propofol-based TIVA, compared to those who received desflurane. Unlike our study population where patients received propofol in combination with other anesthetics including dexmedetomidine, ketamine, lidocaine, celecoxib, pregabalin and tramadol, patients in the studies by Wigmore et al, and Wu et al received a predominantly propofol-based TIVA without any of the oral and IV adjuncts administered in our MA group.…”

“…In the most recent American Joint Committee on Cancer staging system, all appendiceal tumors with peritoneal dissemination are considered stage IV disease [24]. In other studies where a survival benefit of opioid-sparing TIVA has been demonstrated, there has been a trend toward a lesser benefit in patients with metastatic disease and higher ASA scores [14,16]. For example in the study by Wigmore et al [14], the risk associated with volatile anesthetic exposure to patients with metastatic disease was less than that of patients with no metastases.…”

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

“…versus 5.8%), and increased postoperative metastasis rate (43.5% versus 13.4%) than propofol anesthesia group regardless of tumor node metastasis (TNM) stages during the 10 years' follow-up. 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.…”