Propofol-based total intravenous anesthesia improves survival compared to desflurane anesthesia in gastric cancer surgery

Huang, Nian-Cih; Lee, Meei-Shyuan; Lai, Hou-Chuan; Lin, Han-Ting; Huang, Yi‐Hsuan; Lu, Chueng-He; Hsu, Chen-Heng

doi:10.1097/md.0000000000020714

Cited by 23 publications

(45 citation statements)

References 36 publications

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“…A significant finding in the present study is that propofol anesthesia in GBM surgery is associated with better survival and a lower risk of postoperative recurrence than desflurane anesthesia. The result is consistent with our previous studies in which propofol anesthesia demonstrated better survival than desflurane anesthesia following cancer surgeries (intrahepatic cholangiocarcinoma, hepatocellular carcinoma, pancreatic cancer, gastric cancer, prostate cancer, and colon cancer) [ 18 – 23 ]. However, Sessler et al [ 27 ] conducted a randomized controlled trial (RCT) among 2,108 women at 13 hospitals in Argentina, Austria, China, Germany, Ireland, New Zealand, Singapore, and the USA.…”

Section: Discussionsupporting

confidence: 92%

“…As our previous reports [ 18 – 23 ], in brief, propofol anesthesia was maintained at an effect-site concentration (Ce) of 3.0–4.0 μg/mL by a target-controlled infusion (TCI) system (Fresenius Orchestra Primea; Fresenius Kabi AG, Bad Homburg, Germany); desflurane vaporizer was maintained between 4% and 10% (target minimum alveolar concentration of 0.7–1.3) [ 24 ]. During maintenance of anesthesia, all patients received FiO 2 of 100% oxygen at a flow rate of 300 mL/min in a closed breathing system, and desflurane or Ce of propofol was adjusted downward and upward by 0.5–2% or Ce 0.2–0.5 μg/mL, respectively, if needed based on hemodynamics.…”

Section: Methodsmentioning

confidence: 99%

“…Repetitive bolus injections of fentanyl and cisatracurium were administrated as necessary during surgery. The level of EtCO 2 was maintained at 35–45 mmHg [ 18 – 23 ]. All patients were extubated and transferred to the intensive care unit after surgery.…”

Section: Methodsmentioning

confidence: 99%

“…To date, few studies have compared the effects of desflurane versus propofol anesthesia on patient outcomes following GBM surgery. We hypothesized that patients under desflurane anesthesia might have subsequent poor outcomes than patients under propofol anesthesia, as in our previous cancer studies [ 18 – 23 ]. Thus, we performed a retrospective cohort study to examine whether the choice of anesthetic, desflurane versus propofol, is associated with patient survival and postoperative recurrence following GBM surgery.…”

Section: Introductionmentioning

confidence: 99%

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Propofol-based total intravenous anesthesia is associated with better survival than desflurane anesthesia in glioblastoma surgery

et al. 2021

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Background Previous research has shown that anesthetic techniques can influence patient outcomes following cancer surgery. However, the effects of anesthesia in patients undergoing glioblastoma surgery are still not known. We studied the relationship between the type of anesthesia and patient outcomes following elective glioblastoma surgery. Methods This was a retrospective cohort study of patients who underwent elective glioblastoma surgery between January 2008 and December 2018. Patients were grouped according to the anesthesia they received, desflurane or propofol. A Kaplan-Meier analysis was conducted, and survival curves were presented from the date of surgery to death. Univariable and multivariable Cox regression models were used to compare hazard ratios for death after propensity matching. Results A total of 50 patients (45 deaths, 90.0%) under desflurane anesthesia and 53 patients (38 deaths, 72.0%) under propofol anesthesia were included. Thirty-eight patients remained in each group after propensity matching. Propofol anesthesia was associated with improved survival (hazard ratio, 0.51; 95% confidence interval, 0.30–0.85; P = 0.011) in a matched analysis. Furthermore, patients under propofol anesthesia exhibited less postoperative recurrence than those under desflurane anesthesia (hazard ratio, 0.60; 95% confidence interval, 0.37–0.98; P = 0.040) in a matched analysis. Conclusions In this limited sample size, we observed that propofol anesthesia was associated with improved survival and less postoperative recurrence in glioblastoma surgery than desflurane anesthesia. Further investigations are needed to examine the influence of propofol anesthesia on patient outcomes following glioblastoma surgery.

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Section: Discussionsupporting

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Propofol-based total intravenous anesthesia is associated with better survival than desflurane anesthesia in glioblastoma surgery

et al. 2021

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“…More similar studies have been published, some with overall survival at different time points as the main outcome, some studying the duration of recurrence free survival [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 ]. The number of included patients in studies with results that do not support the hypothesis [ 33 , 37 , 38 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ] and studies supporting it [ 34 , 35 , 36 , 39 , 40 , 41 , 51 , 52 , 53 , 54 , 55 , 56 ], are quite equal. If anything, there are more patients in studies without support for the hypothesis.…”

Section: Retrospective Patient Studiesmentioning

confidence: 99%

Is It Definitely Clear That Long-Term Survival after Breast Cancer Surgery Is Not Affected by Anaesthetics?

Enlund

2021

Cancers

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Retrospective studies indicate that cancer survival may be affected by the anaesthetic technique. Propofol seems to be a better choice than volatile anaesthetics, such as sevoflurane. The first two retrospective studies suggested better long-term survival with propofol, but not for breast cancer. Subsequent retrospective studies from Asia indicated the same. When data from seven Swedish hospitals were analysed, including 6305 breast cancer patients, different analyses gave different results, from a non-significant difference in survival to a remarkably large difference in favour of propofol, an illustration of the innate weakness in the retrospective design. The largest randomised clinical trial, registered on clinicaltrial.gov, with survival as an outcome is the Cancer and Anesthesia study. Patients are here randomised to propofol or sevoflurane. The inclusion of patients with breast cancer was completed in autumn 2017. Delayed by the pandemic, one-year survival data for the cohort were presented in November 2020. Due to the extremely good short-term survival for breast cancer, one-year survival is of less interest for this disease. As the inclusions took almost five years, there was also a trend to observe. Unsurprisingly, no difference was found in one-year survival between the two groups, and the trend indicated no difference either.

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The association between intraoperative anesthesia methods used during gastric cancer surgery and long-term mortality: A retrospective observational study using a Japanese claims database

Kagawa,

Kurahashi,

Seki

et al. 2023

J Anesth

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Propofol-based total intravenous anesthesia improves survival compared to desflurane anesthesia in gastric cancer surgery

Cited by 23 publications

References 36 publications

Propofol-based total intravenous anesthesia is associated with better survival than desflurane anesthesia in glioblastoma surgery

Propofol-based total intravenous anesthesia is associated with better survival than desflurane anesthesia in glioblastoma surgery

Is It Definitely Clear That Long-Term Survival after Breast Cancer Surgery Is Not Affected by Anaesthetics?

The association between intraoperative anesthesia methods used during gastric cancer surgery and long-term mortality: A retrospective observational study using a Japanese claims database

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