Anesthesiology. 2020 Oct 1;133(4):764-773. doi: 10.1097/ALN.0000000000003440.
Previous experimental and clinical studies have shown that anesthetic agents have varying effects on cancer prognosis; however, the results were inconsistent among these studies. The authors compared overall and recurrence-free survival in patients given volatile or intravenous anesthesia for digestive tract cancer surgery.
The authors selected patients who had elective esophagectomy, gastrectomy, hepatectomy, cholecystectomy, pancreatectomy, colectomy, and rectal cancer surgery from July 2010 to March 2018 using the Japanese Diagnosis Procedure Combination database. Patients were divided into a volatile anesthesia group (desflurane, sevoflurane, or isoflurane with/without nitrous oxide) and a propofol-based total intravenous anesthesia group. The authors hypothesized that total intravenous anesthesia is associated with greater overall and recurrence-free survival than volatile anesthesia. Subgroup analyses were performed for each type of surgery.
The authors identified 196,303 eligible patients (166,966 patients in the volatile anesthesia group and 29,337 patients in the propofol-based total intravenous anesthesia group). The numbers (proportions) of death in the volatile anesthesia and total intravenous anesthesia groups were 17,319 (10.4%) and 3,339 (11.4%), respectively. There were no significant differences between the two groups in overall survival (hazard ratio, 1.02; 95% CI, 0.98 to 1.07; P = 0.28) or recurrence-free survival (hazard ratio, 0.99; 95% CI, 0.96 to 1.03; P = 0.59), whereas instrumental variable analyses showed a slight difference in recurrence-free survival (hazard ratio, 0.92; 95% CI, 0.87 to 0.98; P = 0.01). Subgroup analyses showed no significant difference in overall or recurrence-free survival between the groups in any type of surgery.
Overall and recurrence-free survival were similar between volatile and intravenous anesthesia in patients having digestive tract surgery. Selection of the anesthetic approach for these patients should be based on other factors.
先前的实验和临床研究表明，麻醉剂对癌症预后有不同的影响；然而，这些研究的结果并不一致。作者比较了接受挥发性或静脉麻醉的消化道癌症手术患者的总生存率和无复发生存率。
作者使用日本诊断程序组合数据库，从 2010 年 7 月至 2018 年 3 月，选择接受择期食管切除术、胃切除术、肝切除术、胆囊切除术、胰切除术、结肠切除术和直肠癌手术的患者。患者分为挥发性麻醉组（地氟烷、七氟烷或异氟烷加/不加一氧化二氮）和依托咪酯为基础的全静脉麻醉组。作者假设全静脉麻醉与更高的总生存率和无复发生存率相关。对每种手术类型进行亚组分析。
作者确定了 196303 名符合条件的患者（挥发性麻醉组 166966 名，依托咪酯为基础的全静脉麻醉组 29337 名）。挥发性麻醉组和全静脉麻醉组的死亡人数（比例）分别为 17319（10.4%）和 3339（11.4%）。两组的总生存率（风险比，1.02；95%置信区间，0.98 至 1.07；P=0.28）或无复发生存率（风险比，0.99；95%置信区间，0.96 至 1.03；P=0.59）均无显著差异，而工具变量分析显示无复发生存率略有差异（风险比，0.92；95%置信区间，0.87 至 0.98；P=0.01）。亚组分析显示，在任何一种手术中，两组的总生存率或无复发生存率均无显著差异。
在接受消化道手术的患者中，挥发性和静脉麻醉的总生存率和无复发生存率相似。选择这些患者的麻醉方法应基于其他因素。
