The choice of anaesthetic--sevoflurane or propofol--and outcome from cancer surgery: a retrospective analysis

Mats Enlund, Anders Berglund, Kalle Andreasson, Catharina Cicek, Anna Enlund, Leif Bergkvist, Mats Enlund, Anders Berglund, Kalle Andreasson, Catharina Cicek, Anna Enlund, Leif Bergkvist

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.

Keywords: Anaesthetics; epidemiology; inhalational; intravenous; local; neoplasm recurrence; survival.

Figures

Figure 1.
Figure 1.
Study population.
Figure 2.
Figure 2.
Kaplan–Meier curve for survival after propofol- or sevoflurane-based anaesthesia for all cancer sites.

References

    1. Inada T, Kubo K, Kambara T, Shingu K. . Can J Anaesth. 2009;56:222–9.
    1. Inada T, Yamanouchi Y, Jomura S, Sakamoto S, Takahashi M, Kambara T, et al. . Anaesthesia. 2004;59:954–9.
    1. Kushida A, Inada T, Shingu K. . Immunopharmacol Immunotoxicol. 2007;29:477–86.
    1. Loop T, Dovi-Akue D, Frick M, Roesslein M, Egger L, Humar M, et al. . Anesthesiology. 2005;102:1147–57.
    1. Matsuoka H, Kurosawa S, Horinouchi T, Kato M, Hashimoto Y. . Anesthesiology. 2001;95:1467–72.
    1. Melamed R, Bar-Yosef S, Shakhar G, Shakhar K, Ben-Eliyahu S. . Anesth Analg. 2003;97:1331–9.
    1. Shapiro J, Jersky J, Katzav S, Feldman M, Segal S. . J Clin Invest. 1981;68:678–85.
    1. Gilliland HE, Armstrong MA, Carabine U, McMurray TJ. . Anesth Analg. 1997;85:1394–8.
    1. Ke JJ, Zhan J, Feng XB, Wu Y, Rao Y, Wang YL. . Anaesth Intensive Care. 2008;36:74–8.
    1. Kotani N, Hashimoto H, Sessler DI, Kikuchi A, Suzuki A, Takahashi S, et al. . Anesthesiology. 1998;89:1125–32.
    1. Schneemilch CE, Ittenson A, Ansorge S, Hachenberg T, Bank U. . J Clin Anesth. 2005;17:517–27.
    1. Biki B, Mascha E, Moriarty DC, Fitzpatrick JM, Sessler DI, Buggy DJ. . Anesthesiology. 2008;109:180–7.
    1. Cummings KC, 3rd, Xu F, Cummings LC, Cooper GS. . Anesthesiology. 2012;116:797–806.
    1. Woods GM, Griffiths DM. . Br J Anaesth. 1986;58:535–9.
    1. Ben-Eliyahu S, Shakhar G, Page GG, Stefanski V, Shakhar K. . Neuroimmunomodulation. 2000;8:154–64.
    1. Graziola E, Elena G, Gobbo M, Mendez F, Colucci D, Puig N. . Rev Esp Anestesiol Reanim. 2005;52:208–16.
    1. Lundy J, Lovett EJ, 3rd, Hamilton S, Conran P. . Cancer. 1978;41:827–30.
    1. Moudgil GC, Singal DP. . Can J Anaesth. 1997;44:90–4.
    1. Mammoto T, Mukai M, Mammoto A, Yamanaka Y, Hayashi Y, Mashimo T, et al. . Cancer Lett. 2002;184:165–70.
    1. Jaloszynski P, Kujawski M, Wasowicz M, Szulc R, Szyfter K. . Mutat Res. 1999;439:199–206.
    1. Karpinski TM, Kostrzewska-Poczekaj M, Stachecki I, Mikstacki A, Szyfter K. . J Appl Genet. 2005;46:319–24.
    1. Braz MG, Magalhaes MR, Salvadori DM, Ferreira AL, Braz LG, Sakai E, et al. . Eur J Anaesthesiol. 2009;26:654–60.
    1. Hoerauf KH, Wiesner G, Schroegendorfer KF, Jobst BP, Spacek A, Harth M, et al. . Br J Anaesth. 1999;82:764–6.
    1. Krause TK, Jansen L, Scholz J, Bottcher H, Wappler F, Burmeister MA, et al. . Mutat Res. 2003;542:59–64.
    1. Wiesner G, Schiewe-Langgartner F, Lindner R, Gruber M. . Anaesthesia. 2008;63:861–4.
    1. Socialstyrelsen [National Board of Health and Welfare] 2011. Dödsorsaker [Causes of Death] [Art. nr. 2011-3-22]. Socialstyrelsen [Stockholm]
    1. Flores LR, Dretchen KL, Bayer BM. . Eur J Pharmacol. 1996;318:437–46.
    1. Vamvakas EC, Blajchman MA. . Blood Rev. 2007;21:327–48.
    1. Freier DO, Fuchs BA. . J Pharmacol Exp Ther. 1993;265:81–8.
    1. Yeager MP, Colacchio TA, Yu CT, Hildebrandt L, Howell AL, Weiss J, et al. . Anesthesiology. 1995;83:500–8.
    1. Bilfinger TV, Fimiani C, Stefano GB. . Int J Cardiol. 1998;64:S61–6.
    1. Jaeger K, Scheinichen D, Heine J, André M, Bund M, Piepenbrock S, et al. . Acta Anaesthesiol Scand. 1998;42:1110–13.
    1. Yeager MP, Procopio MA, DeLeo JA, Arruda JL, Hildebrandt L, Howell AL. . Anesth Analg. 2002;94:94–9. table of contents.
    1. Hadzic A, Glab K, Sanborn KV, Thys DM. . Anesthesiology. 1995;83:863–6.
    1. Koblin DD. . Semin Surg Oncol. 1990;6:141–7.
    1. Fleischmann E, Marschalek C, Schlemitz K, Dalton JE, Gruenberger T, Herbst F, et al. . BMC Anesthesiol. 2009;9:1.
    1. Enlund M, Edmark L, Revenas B. . Br J Anaesth. 2003;90:686–8.
    1. Gottschalk A, Ford J, Regelin C, You J, Mascha E, Sessler DI, et al. . Anesthesiology. 2010;113:27–34.
    1. Gordon RJ. . Anesth Analg. 2012;114:694–9.

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