Early and Long-Term Outcomes after Propofol-and Sevoflurane-Based Anesthesia in Colorectal Cancer Surgery: A Retrospective Study

Abstract

Background: Propofol is considered to protect against immunosuppression and has lower inflammatory responses in the perioperative period than volatile agents. We evaluated whether the anesthetic agent is associated with cancer outcomes. Methods: We retrospectively reviewed 2616 patients who underwent colorectal cancer surgery under general anesthesia between 2016 and 2018 (follow-up closure: July 2021) at a single institution. Patients received propofol-based total intravenous anesthesia or sevoflurane-based inhalational anesthesia. After propensity score matching, the postoperative neutrophil-lymphocyte ratio (NLR) was compared as primary outcome, and clinical outcomes were evaluated. Results: After 1:2 propensity matching, 717 patients were given propofol anesthesia and 1410 patients were given sevoflurane anesthesia. In the matched cohort, preoperative NLR was not significantly different between propofol and sevoflurane anesthesia (mean (95% CI)2.3 (1.8 to 2.8) and 2.2 (1.9 to 3.2); p = 0.72). NLR was significantly lower in propofol anesthesia at postoperative day two and five (mean difference (95% CI) 0.71 (0.43 to 0.98); p = 0.000 and 0.52 (0.30 to 0.74); p = 0.000). Urinary retention showed a higher incidence after propofol anesthesia (4.9% vs. 2.6%; p = 0.008). Other postoperative complications and overall/recurrence-free survival were not different in the two groups. Discussion: Although propofol anesthesia showed lower postoperative NLR than sevoflurane anesthesia, there was no association with clinical outcomes.

Effect of different anaesthetic techniques on the prognosis of patients with colorectal cancer after resection: a systematic review and meta-analysis

“…After identifying 4315 references, 1035 duplicate publications and 3205 irrelevant studies were excluded, leaving 75 potentially eligible studies ( Figure 1 ). Finally, six cohort ( 17 , 18 , 21 – 24 ) studies conducted between 2014 and 2022 were included in the meta-analysis.…”

“…A retrospective analysis showed that volatile anaesthetics slightly increased the cancer recurrence rate in patients undergoing colorectal cancer surgery compared with TIVA using propofol ( 17 ). Another study ( 18 ) showed that there was no difference in overall survival (OS) or recurrence-free survival (RFS) between the two anaesthesia methods for colorectal cancer.…”

Postoperative Long-Term Outcomes and Independent Risk Factors of Non-Small-Cell Lung Cancer Patients With Propofol versus Sevoflurane Anesthesia: A Retrospective Cohort Study

“…The stress response and immunosuppression caused by the operation stimulated the progression of tumor cells during the perioperative period. Propofol was reported to have less immunosuppression and has a lower inflammatory response than volatile drugs during the perioperative period (Lee et al, 2022). This may reduce opioid use for pain relief and may have favorable to contribute outcomes (Moorthy et al, 2021).…”

Impact of general or regional anaesthesia on recurrence of colorectal cancer after surgery: Systematic review

“…The intervention groups in four studies included a comparison between RA and GA versus RA, and the two studies compared inhalational versus TIVA. [ 9 10 11 12 13 14 ] Due to overall heterogeneity and lack of data in the studies, two studies were used for data synthesis for the primary outcome of cancer recurrence. Gottschalk et al .…”