Outcomes of intravenous and inhalation anesthesia on patients undergoing esophageal cancer surgery: a retrospective observational study

Abstract

Background Different anesthetics may have opposite effects on the immune system, thus affecting the prognosis of tumor patients. Cell-mediated immunity forms the primary defense against the invasion of tumor cells, so manipulation of the immune system to produce an enhanced anti-tumor response could be utilized as an adjuvant oncological therapy. Sevoflurane has proinflammatory effects, while propofol, has anti-inflammatory and antioxidant effects. Therefore, we compared the overall survival (OS) and disease-free survival (DFS) of patients with esophageal cancer under total intravenous anesthesia and inhalation anesthesia. Methods This study collected the electronic medical records of patients undergoing esophagectomy from January 1, 2014 to December 31, 2016. According to the intraoperative anesthetics, the patients were divided into total intravenous anesthesia (TIVA) group or inhalational anesthesia (INHA) group. Stabilized inverse probability of treatment weighting (SIPTW) was used to minimize differences. Kaplan–Meier survival curve was established to evaluate the correlation between different anesthesia methods in overall survival and disease-free survival of patients undergoing esophageal cancer surgery. Results A total of 420 patients with elective esophageal cancer were collected, including 363 patients eligible for study (TIVA, n = 147, INHA, n = 216). After SIPTW there were no significant differences between two groups in overall survival and disease-free survival. However, the adjuvant therapy was statistically significant in improving OS, and the degree of differentiation was correlated with OS and DFS. Conclusions In conclusion, there were no significant difference in overall survival and disease-free survival between total intravenous anesthesia and inhalational anesthesia in patients undergoing esophageal cancer surgery.

Effects of anesthesia on long-term survival in cancer surgery: A systematic review and meta-analysis

“…Forty-two retrospective cohort studies and two RCTs with a total of 686,923 patients were included in this study [ [19] , [20] , [21] , [22] , [23] , [24] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] ]. Thirty-five trials were single-center studies [ 19 , [21] , [22] , [23] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [50] , [51] , …”

“…In total, two studies enrolled participants undergoing surgery for glioblastoma [ 47 , 56 ], one study for oral cancer [ 63 ], nine studies for breast cancer [ 34 , 37 , 42 , 45 , 49 , 53 , 59 , 61 , 71 ], five studies for non-small cell lung cancer [ 38 , 55 , 60 , 65 , 69 ], two studies for esophageal cancer [ 36 , 68 ], four studies for gastric cancer [ 40 , 44 , 50 , 57 ], five studies for colorectal cancer [ 34 , 39 , 48 , 54 , 62 ], four studies for hepatobiliary cancer [ 19 , 41 , 43 , 51 ], two studies for pancreatic cancer [ 52 , 64 ], two studies for gynecological cancer [ 21 , 22 ], two studies for urological cancer [ 23 , 58 ], one study for osteosarcoma [ 66 ], and six studies for various cancers [ 20 , 24 , 35 , 46 , 68 , 70 ]. For inhalation anesthetics, seventeen studies used sevoflurane to maintain anesthesia [ 19 , 21 , 34 , 38 , 40 , [47] , [48] , [49] , 53 , 59 , [62] , [63] , [64] , [65] , 6...…”

“…For inhalation anesthetics, seventeen studies used sevoflurane to maintain anesthesia [ 19 , 21 , 34 , 38 , 40 , [47] , [48] , [49] , 53 , 59 , [62] , [63] , [64] , [65] , 67 , 70 , 71 ], nine studies used desflurane [ 22 , 39 , [41] , [42] , [43] , 50 , 52 , 56 , 66 ] and eighteen studies administered various inhalation anesthetics [ 20 , 23 , 24 , [35] , [36] , [37] , [44] , [45] , [46] , 51 , 54 , 55 , 57 , 58 , 60 , 61 , 68 , 69 ]. Twenty-six studies included elective surgery [ 19 , 21 , 22 , 36 , [38] , [39] , [40] , [41] , 43 , 44 , [46] , [47] , [48] , [50] , [51] , [52] , [53] , 56 , 60 , [62] , [63] , …”

“…Forty studies reported OS [ 19 , 20 , [22] , [23] , [24] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , 52 , [54] , [55] , [56] , [57] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] ]. When compared with inhalation anesthesia, propofol-based anesthesia was associated with better OS (HR = 0.82, 95 % CI:0.76–0.88, P < 0.00001, I 2 = 82 %) ( Fig.…”

“…Nine multicenter studies [ 20 , 24 , 49 , 54 , 59 , 61 , 68 , 70 , 71 ] and thirty-one single-center studies [ 19 , 22 , 23 , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , 50 , 52 , [55] , [56] , [57] , 60 , [62] , [63] , [64] , [65] , [66] , [67] , 69 ] reported on OS. Multicenter studies indicated that propofol-based anesthesia had no advantage in OS compared with inhalation anesthesia (HR = 0.98, 95 % CI:0.94–1.03, P = 0.51, I 2 = 56 %).…”