Propofol-based total intravenous anesthesia is associated with better survival than desflurane anesthesia in robot-assisted radical prostatectomy

Abstract

Background Previous researches have shown that anesthetic techniques may influence the patients' outcomes after cancer surgery. Here, we studied the relationship between the type of anesthetic techniques and patients' outcomes following elective robot-assisted radical prostatectomy. Methods This was a retrospective cohort study of patients who received elective, robot-assisted radical prostatectomy between January 2008 and December 2018. Patients were grouped according to the anesthesia they received, namely 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. Subgroup analyses were performed for tumornode-metastasis stage and disease progression. The primary outcome was overall survival, and the secondary outcome was postoperative biochemical recurrence. Results A total of 365 patients (24 deaths, 7.0%) under desflurane anesthesia, and 266 patients (2 deaths, 1.0%) under propofol anesthesia were included. The all-cause mortality rate was significantly lower in the propofol anesthesia than in the desflurane anesthesia during follow-up (P = 0.001). Two hundred sixty-four patients remained in each group after propensity matching. The propofol anesthesia was associated with improved overall survival (hazard ratio, 0.11; 95% confidence interval, 0.03-0.48; P = 0.003) in the matched analysis.

Propofol-based intravenous anesthesia is associated with better survival than desflurane anesthesia in pancreatic cancer surgery

“…10% in 100% oxygen at a flow of 0.3 L/min in a closed breathing system in the desflurane group. Repetitive bolus injections of fentanyl and cisatracurium were used as needed during surgery [16][17][18]. Desflurane or maintenance of the Ce with TCI using propofol was adjusted downward and upward by 0.5-2% or 0.2-0.5 μg/mL, respectively, when needed based on the hemodynamics.…”

“…The level of ETCO2 was kept at 35-45 mmHg by adjusting the ventilation rate with a maximum airway pressure < 30 cm H 2 O. After surgery, cases were transferred to the postanesthesia or intensive care unit and evaluated by the anesthesiologist in charge [16][17][18].…”

Effects of propofol on the development of cancer in humans

“…9 Additionally, another retrospective cohort study found that propofol anaesthesia was related to better OS and a lower postoperative biochemical recurrence rate than those with desflurane anaesthesia in patients undergoing robot-assisted radical prostatectomy. 85 However, these previous studies have the limitations of most retrospective investigations. Hence, a prospective trial was warranted to evaluate the effect of propofol on bladder cancer outcomes.…”

“…Notably, a meta‐analysis study including 7866 patients with different types of cancer discovered that the use of propofol improved the OS and RFS of cancer in comparison with the use of inhalational anaesthesia 9 . Additionally, another retrospective cohort study found that propofol anaesthesia was related to better OS and a lower postoperative biochemical recurrence rate than those with desflurane anaesthesia in patients undergoing robot‐assisted radical prostatectomy 85 . However, these previous studies have the limitations of most retrospective investigations.…”

Positive Impact of Intraoperative Epidural Ropivacaine Infusion on Oncologic Outcomes in Pancreatic Cancer Patients Undergoing Pancreatectomy: A Retrospective Cohort Study

“…Currently, surgical resection is only possible curative treatment for pancreatic cancer. However, surgical intervention might impair cell-mediated immunity and activated circulating tumor cells implantation which leave patients susceptible to develop of postoperative recurrence or metastasis 3 , 4 . Multiple retrospective studies have shown that regional anesthesia improved patient outcome after surgery in bladder, breast and lung cancers 5 - 7 .…”