Effects of propofol-based total intravenous anesthesia on recurrence and overall survival in patients after modified radical mastectomy: a retrospective study

Abstract

BackgroundThe optimal combination of anesthetic agent and technique may have an influence on long-term outcomes in cancer surgery. In vitro and in vivo studies suggest that propofol independently reduces migration of cancer cells and metastasis. Thus, the authors retrospectively examined the link between propofol-based total intravenous anesthesia (TIVA) and recurrence or overall survival in patients undergoing modified radical mastectomy (MRM).MethodsA retrospective analysis of the electronic database of all patients undergoing MRM for breast cancer between January 2007 and December 2008 was undertaken. Patients received either propofol-based TIVA (propofol group) or sevoflurane-based anesthesia (sevoflurane group). We analyzed prognostic factors of breast cancer and perioperative factors and compared recurrence-free survival and overall survival between propofol and sevoflurane groups.ResultsA total of 363 MRMs were carried out during the period of the trial; 325 cases were suitable for analysis (173 cases of propofol group, and 152 cases of sevoflurane group). There were insignificant differences between the groups in age, weight, height, histopathologic results, surgical time, or postoperative treatment (chemotherapy, hormonal therapy, and radiotherapy). The use of opioids during the perioperative period was greater in propofol group than in sevoflurane group. Overall survival was no difference between the two groups. Propofol group showed a lower rate of cancer recurrence (P = 0.037), with an estimated hazard ratio of 0.550 (95% CI 0.311–0.973).ConclusionsThis retrospective study provides the possibility that propofol-based TIVA for breast cancer surgery can reduce the risk of recurrence during the initial 5 years after MRM.

Outcomes of outpatient breast cancer surgery at a private breast clinic

“…Anesthetic‐induced immunosuppression may differ between GA and local anesthesia/anesthetic sedation, and local anesthesia may reduce cancer recurrence and cancer‐related mortality. This difference may explain why previous retrospective studies on anesthetic techniques and cancer outcomes showed conflicting results in patients with breast cancer . Clinical trials are ongoing to compare different anesthetics in patients undergoing breast cancer surgery (NCT00418457; NCT02089178).…”

<p>Anesthetic Strategies in Oncological Surgery: Not Only a Simple Sleep, but Also Impact on Immunosuppression and Cancer Recurrence</p>

“…52 Another retrospective analysis of 325 patients, having received surgery for breast cancer, also suggested a possible reduction of cancer recurrence in patients anesthetized with propofol, as opposed to those with volatile agents. 53 However, no difference was reported in the overall survival between the two groups. 53 Another retrospective study investigated the role of different anesthetic strategy in 156 patients who underwent free flap surgery for head and neck cancer.…”

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

“…7 Numerous retrospective analysis investigations have shown that cancer patients anaesthetized with sevoflurane had worse clinical outcomes than those received anesthesia with propofol in the surgery for breast, colon, rectal and gastric cancers. 8,9 Furthermore, compared with the propofol group, the sevoflurane group displayed a higher rate of cancer recurrence in breast cancer patients undergoing modified radical mastectomy, 10 and increased the risk of death in patients with high-grade glioma undergoing tumor resection. 11 But recently, a randomized control trial involved in more than 2000 women who underwent breast cancer surgery demonstrated that there was no significant difference in breast cancer recurrence rate among women receiving general anesthesia (sevoflurane and opioids) and regional anesthesia analgesia (paravertebral block and propofol).…”