全凭静脉麻醉与吸入麻醉用于乳腺癌手术的比较：一项回顾性队列研究。
Total Intravenous Anesthesia versus Inhalation Anesthesia for Breast Cancer Surgery: A Retrospective Cohort Study.
机构信息
From the Departments of Anesthesiology and Pain Medicine (S.Y., S.-K.P., W.H.K., J.-T.K.) Surgery (H.-B.L., W.H., D.-Y.N.), Seoul National University Hospital the Cancer Research Institute (H.-B.L., W.H., D.-Y.N.), Seoul National University, Seoul, Korea.
出版信息
Anesthesiology. 2019 Jan;130(1):31-40. doi: 10.1097/ALN.0000000000002491.
BACKGROUND
The association between type of anesthesia used and recurrence of cancer remains controversial. This retrospective cohort study compared the influence of total IV anesthesia and inhalation anesthesia on the primary outcome of recurrence-free survival after breast cancer surgery.
METHODS
The authors reviewed the electronic medical records of patients who had breast cancer surgery at a tertiary care teaching hospital between January 2005 and December 2013. The patients were grouped according to whether IV or inhalation anesthesia was used for surgery. Propensity score matching was used to account for differences in baseline characteristics. Kaplan-Meier survival curves were constructed to evaluate the influence of type of anesthesia on recurrence-free survival and overall survival. The risks of cancer recurrence and all-cause mortality were compared between each type of anesthesia.
RESULTS
Of 7,678 patients who had breast cancer surgery during the study period, data for 5,331 patients were available for analysis (IV group, n = 3,085; inhalation group, n = 2,246). After propensity score matching, 1,766 patients remained in each group. Kaplan-Meier survival curves showed that there was no significant difference in recurrence-free survival or overall survival between the two groups, with 5-yr recurrence-free survival rates of 93.2% (95% CI, 91.9 to 94.5) in the IV group and 93.8% (95% CI, 92.6 to 95.1) in the inhalation group. Inhalation anesthesia had no significant impact on recurrence-free survival (hazard ratio, 0.96; 95% CI, 0.69 to 1.32; P = 0.782) or overall survival (hazard ratio, 0.96; 95% CI, 0.69 to 1.33, P = 0.805) when compared with total IV anesthesia.
CONCLUSIONS
The authors found no association between type of anesthesia used and the long-term prognosis of breast cancer. The results of this retrospective cohort study do not suggest specific selection of IV or inhalation anesthesia for breast cancer surgery.
背景
麻醉方式与癌症复发之间的关联仍存在争议。本回顾性队列研究比较了全身静脉麻醉和吸入麻醉对乳腺癌手术后无复发生存这一主要结局的影响。
方法
作者回顾了 2005 年 1 月至 2013 年 12 月在一家三级教学医院接受乳腺癌手术的患者的电子病历。根据手术时使用的是静脉麻醉还是吸入麻醉将患者分为两组。使用倾向评分匹配来考虑基线特征的差异。构建 Kaplan-Meier 生存曲线来评估麻醉方式对无复发生存和总生存的影响。比较每种麻醉方式下癌症复发和全因死亡率的风险。
结果
在研究期间接受乳腺癌手术的 7678 例患者中，有 5331 例患者的数据可用于分析（静脉组，n=3085；吸入组，n=2246）。经过倾向评分匹配后，每组仍有 1766 例患者。Kaplan-Meier 生存曲线显示两组无复发生存或总生存无显著差异，静脉组 5 年无复发生存率为 93.2%（95%CI，91.9 至 94.5），吸入组为 93.8%（95%CI，92.6 至 95.1）。与全静脉麻醉相比，吸入麻醉对无复发生存（风险比，0.96；95%CI，0.69 至 1.32；P=0.782）或总生存（风险比，0.96；95%CI，0.69 至 1.33，P=0.805）均无显著影响。
结论
作者发现麻醉方式与乳腺癌的长期预后之间没有关联。本回顾性队列研究的结果并不表明乳腺癌手术应具体选择静脉或吸入麻醉。
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