The choice of anaesthetic—sevoflurane or propofol—and outcome from cancer surgery: A retrospective analysis

Abstract

Background Commonly used inhalational hypnotics, such as sevoflurane, are pro-inflammatory, whereas the intravenously administered hypnotic agent propofol is anti-inflammatory and anti-oxidative. A few clinical studies have indicated similar effects in patients. We examined the possible association between patient survival after radical cancer surgery and the use of sevoflurane or propofol anaesthesia.Patients and methods Demographic, anaesthetic, and surgical data from 2,838 patients registered for surgery for breast, colon, or rectal cancers were included in a database. This was record-linked to regional clinical quality registers. Cumulative 1- and 5-year overall survival rates were assessed using the Kaplan–Meier method, and estimates were compared between patients given propofol (n = 903) or sevoflurane (n = 1,935). In a second step, Cox proportional hazard models were calculated to assess the risk of death adjusted for potential effect modifiers and confounders.Results Differences in overall 1- and 5-year survival rates for all three sites combined were 4.7% (p = 0.004) and 5.6% (p < 0.001), respectively, in favour of propofol. The 1-year survival for patients operated for colon cancer was almost 10% higher after propofol anaesthesia. However, after adjustment for several confounders, the observed differences were not statistically significant.Conclusion Propofol anaesthesia might be better in surgery for some cancer types, but the retrospective design of this study, with uneven distributions of several confounders, distorted the picture. These uncertainties emphasize the need for a randomized controlled trial.

Anesthesia, surgical stress, and “long-term” outcomes

“…45 Furthermore, a retrospective study, reporting the data from 2838 patients registered for surgery for breast, colon, or rectal cancer, showed that propofol anesthesia might be better than sevoflurane in surgery for some cancer types for 1-year survival, however, after adjustment for several confounders, the observed differences were not statistically significant. 46 These studies are summarized in Table 2.…”

Effect of sevoflurane on human hepatocellular carcinoma HepG2 cells under conditions of high glucose and insulin

“…Enlund et al [4] reported in a previous clinical study that patients anesthetized with sevoflurane may have shorter overall survival rates than patients anesthetized with propofol during cancer surgery. Several recent in vitro studies Two percent sevoflurane at 100 or 300 mg/dl of glucose concentration with various insulin concentrations.…”

“…In a retrospective study, sevoflurane, one of the most commonly used volatile general anesthetics for cancer surgery patients, leads to lower overall survival rates than propofol [4]. Furthermore, several in vitro studies have revealed that sevoflurane increases cancer cell proliferation [5,6].…”

Anaesthesia for oncological surgery – can it really influence cancer recurrence?

“…A retrospective analysis of breast, colon and rectal cancer surgery found an improved one-and five-year overall survival of 4.7% and 5.6%, respectively, with total intravenous anaesthesia compared with sevoflurane anaesthesia [26], and preliminary data from an ongoing prospective randomised controlled trial for radical cystectomy supports these findings by demonstrating improved immune function with total intravenous anaesthesia, namely enhanced cell-mediated immunity [27].…”