a Department of Anesthesiology and Perioperative Medicine , The University of Texas MD Anderson Cancer Center , Houston , TX , USA.
b Anesthesiology and Surgical Oncology Research Group , Houston , TX , USA.
Int J Hyperthermia. 2019;36(1):369-375. doi: 10.1080/02656736.2019.1574985. Epub 2019 Mar 4.
Studies suggest volatile anesthetics and opioids may enhance the malignant potential of cancer cells. The objective of this single institution retrospective study was to evaluate the survival impact of a multimodal opioid-sparing nonvolatile anesthetic technique (MA) in a group of patients who had undergone cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for appendiceal carcinomatosis.
Propensity score matching (PSM) and Cox proportional hazard models were used to compare the survivals of patients who received MA (MA group), to those who received volatile-opioid anesthesia (volatile-opioid group).
Of the 373 patients, 110 (29%) were in the MA group and 263 (71%) in the volatile-opioid group. The MA group was older (mean ± standard deviation (SD): 55 ± 11 versus 53 ± 10 years, p = .035) and had more patients with ASA scores 3 or 4 (90% versus 81%, p = .032), and those with high grade tumors (18% versus 12%, p = .009). Intraoperative opioid consumption was lower in the MA group (mean morphine equivalents ± SD: 13 ± 10 versus 194 ± 789, p < .0001). After PSM, 107 patients remained in each group. In the adjusted Cox proportional hazards model after PSM, MA was not associated with improved progression free survival (PFS) (HR 1.45, 95% CI [0.94-2.22], p = .093) or overall survival (OS) (HR 1.66, 95% CI [0.86-3.20], p = .128), when compared to volatile-opioid anesthesia.
In this retrospective study, a multimodal opioid-sparing nonvolatile anesthetic approach was not associated with improved survival. Precis' statement: In this study of patients undergoing major cancer surgery, the use of multimodal anesthetic and analgesic agents, while avoiding volatile anesthetics and minimizing opioid use was not associated with improved survival.
研究表明挥发性麻醉剂和阿片类药物可能会增强癌细胞的恶性潜能。本单机构回顾性研究的目的是评估接受细胞减灭术联合腹腔热灌注化疗（CRS-HIPEC）的阑尾癌患者中，多模式阿片类药物节约型非挥发性麻醉技术（MA）的生存影响。
采用倾向评分匹配（PSM）和 Cox 比例风险模型比较 MA 组（MA 组）和挥发性阿片类药物麻醉组（挥发性阿片类药物组）患者的生存情况。
373 例患者中，110 例（29%）为 MA 组，263 例（71%）为挥发性阿片类药物组。MA 组年龄较大（平均±标准差（SD）：55±11 岁比 53±10 岁，p=0.035），ASA 评分 3 或 4 级的患者更多（90%比 81%，p=0.032），且高级别肿瘤患者更多（18%比 12%，p=0.009）。MA 组术中阿片类药物用量较低（平均吗啡当量±SD：13±10 比 194±789，p<0.0001）。PSM 后，每组仍有 107 例患者。PSM 后调整的 Cox 比例风险模型显示，MA 与无进展生存期（PFS）（HR 1.45，95%CI [0.94-2.22]，p=0.093）或总生存期（OS）（HR 1.66，95%CI [0.86-3.20]，p=0.128）的改善无关。
在这项回顾性研究中，多模式阿片类药物节约型非挥发性麻醉方法与生存改善无关。
