腹部手术后高围术期吸入氧分数与新发或复发性癌症风险。
Risk of new or recurrent cancer after a high perioperative inspiratory oxygen fraction during abdominal surgery.
机构信息
Department of Anaesthesiology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark
Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark.
出版信息
Br J Anaesth. 2014 Jul;113 Suppl 1:i74-i81. doi: 10.1093/bja/aeu110. Epub 2014 May 23.
BACKGROUND
Administration of supplemental oxygen in the perioperative period is controversial, as it may increase long-term mortality. Our aim was to assess the association between 80% oxygen and occurrence of subsequent cancer in patients undergoing abdominal surgery in a post hoc analysis of the PROXI trial.
METHODS
The 1386 patients in the PROXI trial underwent elective or emergency laparotomy between 2006 and 2008 with randomization to either 80% or 30% oxygen during and for 2 h after surgery. We retrieved follow-up status regarding vital status, new cancer diagnoses, and new histological cancer specimens. Data were analysed using the Cox proportional hazards model.
RESULTS
Follow-up was complete in 1377 patients (99%) after a median of 3.9 yr. The primary outcome of new cancer diagnosis or new malignant histological specimen occurred in 140 of 678 patients (21%) in the 80% oxygen group vs 150 of 699 patients (21%) assigned to 30% oxygen; hazards ratio 1.06 [95% confidence interval (CI) 0.84, 1.34], P=0.62. Cancer-free survival was significantly shorter in the 80% oxygen group; hazards ratio 1.19 (95% CI 1.01, 1.42), P=0.04, as was the time between surgery and new cancer, median 335 vs. 434 days in the 30% oxygen group. In patients with localized disease, non-significant differences in cancer and cancer-free survival were found with hazard ratios of 1.31 and 1.29, respectively.
CONCLUSIONS
Although new cancers occurred at similar rate, the cancer-free survival was significantly shorter in the 80% oxygen group, but this did not appear to explain the excess mortality in the 80% oxygen group.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov (NCT01723280).
背景
围手术期补充氧气的管理存在争议，因为它可能会增加长期死亡率。我们的目的是在 PROXI 试验的事后分析中评估接受腹部手术的患者接受 80%氧气与随后发生癌症之间的关联。
方法
PROXI 试验中的 1386 名患者在 2006 年至 2008 年间接受择期或急诊剖腹手术，随机分配至手术中和手术后 2 小时内接受 80%或 30%氧气。我们检索了有关生存状态、新癌症诊断和新组织学癌症标本的随访情况。使用 Cox 比例风险模型进行数据分析。
结果
在中位随访 3.9 年后，1377 名患者（99%）完成了随访。80%氧气组中 678 名患者中有 140 名（21%）出现新癌症诊断或新恶性组织学标本，而 30%氧气组中 699 名患者中有 150 名（21%）；风险比 1.06 [95%置信区间（CI）0.84, 1.34]，P=0.62。80%氧气组的无癌生存率显著较短；风险比 1.19（95%CI 1.01, 1.42），P=0.04，以及手术和新发癌症之间的时间，30%氧气组中位数为 335 天，80%氧气组为 434 天。在局部疾病患者中，发现癌症和无癌生存率的差异无统计学意义，风险比分别为 1.31 和 1.29。
结论
尽管新癌症的发生率相似，但 80%氧气组的无癌生存率显著较短，但这似乎并不能解释 80%氧气组的超额死亡率。
临床试验注册
ClinicalTrials.gov（NCT01723280）。
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