From the Departments for *Anesthesia and Intensive Care and †Clinical Physiology, Lanssjukhuset, Kalmar; Department of Medicine and Health Sciences, University Hospital Linköping, Linköping; and ‡Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden.
Anesth Analg. 2014 Apr;118(4):782-7. doi: 10.1213/ANE.0000000000000097.
Preclinical data indicate that anesthesia and surgery may promote cancer growth. We previously found no increased risk of malignant disease within 5 years regarding duration of general anesthesia (TANESTH) and time with Bispectral Index (BIS) under 45 (TBIS < 45) in patients without any diagnosis or history of malignancy before or within 1 month after surgery. Because immunocompetence may be different in patients with previous malignant disease, we investigated the corresponding risk in patients with earlier or existing malignant disease at the time of surgery.
In a prospective cohort of 766 BIS-monitored patients anesthetized with sevoflurane, new malignant diagnoses and death within 5 years after surgery were retrieved. Cox regression was used to assess the risk of new cancer and all-cause death during follow-up in relation to (TANESTH) and (TBIS <45).
Fifty-one patients (6.7%) were assigned 54 new malignant diagnoses within 5 years after surgery. Cancer surgery comprised 387 (51%) of the index operations. Two hundred ninety-three (38 %) of the patients died during follow-up. No relation between TANESTH or TBIS <45 and new malignant disease (hazard ratio [HR] 0.64-1.11 and 0.76-1.30, respectively) or death was found (HR 0.85-1.05 and 0.94-1.16, respectively). Nor were any corresponding significant relations obtained when other thresholds for BIS (i.e., < 30, 40, and 50, respectively) were investigated.
In patients with previous or existing malignant disease, neither duration of anesthesia nor increased cumulative time with profound sevoflurane anesthesia was associated with an increased risk for new cancer or death within 5 years after surgery. Monitoring "depth of anesthesia" is not expected to alter the risk of cancer proliferation after surgery.
临床前数据表明麻醉和手术可能会促进癌症生长。我们之前发现，在没有癌症诊断或病史的患者中，全身麻醉时间（TANESTH）和双频谱指数（BIS）低于 45 （TBIS < 45）与 5 年内恶性疾病的风险没有增加。由于免疫能力在先前患有恶性疾病的患者中可能不同，因此我们研究了手术时患有先前或现有的恶性疾病的患者的相应风险。
在一项使用七氟醚麻醉的 766 名 BIS 监测患者的前瞻性队列中，检索了手术后 5 年内新发恶性诊断和死亡病例。使用 Cox 回归评估了随访期间新癌症和全因死亡的风险与（TANESTH）和（TBIS <45）的关系。
51 例患者（6.7%）在手术后 5 年内被诊断出 54 例新发恶性肿瘤。癌症手术占指数手术的 387 例（51%）。293 例（38%）患者在随访期间死亡。未发现 TANESTH 或 TBIS <45 与新发恶性疾病（风险比 [HR] 0.64-1.11 和 0.76-1.30）或死亡（HR 0.85-1.05 和 0.94-1.16）之间存在任何关系。当研究其他 BIS 阈值（即分别为<30、40 和 50）时，也未获得任何相应的显著关系。
在先前或现有的恶性疾病患者中，麻醉时间的长短或深度镇静时间的累积都与手术后 5 年内新发癌症或死亡的风险增加无关。监测“麻醉深度”预计不会改变手术后癌症增殖的风险。
