Effects of propofol-based total intravenous anesthesia on gastric cancer: a retrospective study

Abstract

BackgroundSeveral kinds of cancer surgeries with propofol-based total intravenous anesthesia (TIVA) have been shown to have better outcomes than those with sevoflurane-based inhalational anesthesia (INHA). However, the effects of this anesthetic technique have not been investigated in patients with gastric cancer. In this study, the authors retrospectively examined the link between the choice of anesthetic technique and overall survival in patients undergoing gastric cancer resection.MethodsWe conducted a retrospective analysis of the database of all patients undergoing gastric cancer resection for gastric cancer between 2007 and 2012. Patients who received TIVA or INHA were administered patient-controlled intravenous analgesia for 72–120 hours postoperatively. Survival was estimated using the Kaplan–Meier log-rank test, and associations between anesthetic technique and outcomes were analyzed using Cox proportional hazards regressions after propensity matching.ResultsA total of 2,856 anesthetics using INHA or TIVA were delivered in the study period. After propensity matching, 897 patients remained in each group. According to Kaplan–Meier analysis, the use of TIVA was associated with improved survival (P<0.001). TIVA was associated with a hazard ratio (HR) of 0.67 (95% confidence interval [CI]: 0.58–0.77) for death in univariate analysis and 0.65 (95% CI: 0.56–0.75) after a multivariate analysis of known confounders in the matched group. Cancer stage (HR =0.74, 95% CI: 0.64–0.86, P<0.001) and degree of differentiation (HR =1.28, 95% CI: 1.11–1.47, P<0.001) were also associated with survival in the univariate analysis in the matched group. In the multivariable Cox model, cancer stage (HR =0.72, 95% CI: 0.62–0.84, P<0.001) and degree of differentiation (HR =1.23, 95% CI: 1.07–1.42, P<0.001) were associated with survival in the matched group.ConclusionThese results indicate that TIVA may be associated with improved survival in gastric cancer patients who undergo resection.

Anesthetic technique and cancer outcomes: a meta-analysis of total intravenous versus volatile anesthesia

“…All studies except Yan et al 19 adjusted for at least one of the following variables in their multivariate analyses: age, body mass index, comorbidities, preoperative therapy, pathologic stage or grade of cancer, and intraoperative anesthetic interventions such as epidural or blood transfusion. [12][13][14][15][16][17][18]20,21…”

“…All the nine retrospective studies had a NOS C 7 demonstrating good methodologic quality and a low risk of bias. [12][13][14][15][16][17][18]20,21 The single prospective RCT included in this meta-analysis had a low risk of bias for each domain. 19…”

“…Eight studies (seven retrospective 12,13,[16][17][18]20,21 and one RCT), 19 that included a total of 18,778 patients, provided ten HRs for this analysis (Fig. 3) in breast, colorectal, gastric, esophageal, and non-small cell lung cancer, and mixed cancer types.…”

The mechanism of propofol in cancer development: An updated review

“…found that the effect of propofol on cellular immune responses was slightly lower than that of sevoflurane . In 2018, a retrospective analysis indicated that propofol‐based total intravenous anesthesia could be associated with improved survival in patients undergoing gastric cancer resection . Liu et al.…”

“…71 In 2018, a retrospective analysis indicated that propofol-based total intravenous anesthesia could be associated with improved survival in patients undergoing gastric cancer resection. 72 Liu et al proved that propofol was superior to isoflurane and enflurane at inhibiting serum IL-8 secretion and increasing IL-10 secretion and could be considered a better anesthetic agent for inhibiting a traumatic inflammatory response. 73 However, a recent study showed that propofol was not better than sevoflurane in terms of NK and CTL cell counts and apoptotic rates during anesthesia for breast cancer surgery in a clinical setting.…”