Center for Surgical Science, Zealand University Hospital, Koege, Denmark.
Clinical Pharmacology and Pharmacy, Odense University Hospital, Odense, Denmark.
Br J Anaesth. 2021 May;126(5):921-930. doi: 10.1016/j.bja.2020.11.019. Epub 2020 Dec 30.
During colorectal cancer surgery, the immune-modulating effects of inhalation anaesthesia may create a favourable environment for metastasis formation, leading to increased risk of recurrence. Our aim was to assess the association between inhalation vs intravenous anaesthesia and cancer recurrence in patients undergoing colorectal cancer surgery.
Patients undergoing colorectal cancer surgery in 2004-18 were identified in the Danish Colorectal Cancer Group Database and Danish Anaesthesia Database. After exclusion of patients with residual tumour registered in postoperative pathology reports, local endoscopic resections, and stent insertions, we classified patients according to exposure to inhalation anaesthesia. The primary outcome was recurrence (time to recurrence), whereas secondary outcomes were all-cause mortality (time to death) and disease-free survival (time to either recurrence or death). Events of recurrence and death were identified using The Danish Civil Registration System, Danish National Pathology Registry, and Danish National Patient Registry. The sub-distribution hazards approach was used to estimate hazard ratios (HRs) for recurrence, and Cox regression was used for all-cause mortality and disease-free survival.
We identified 5238 patients exposed to inhalation anaesthesia and 6322 to intravenous anaesthesia. Propensity score matching yielded 4347 individuals in each group with balanced baseline covariates. We found a weak association between recurrence and exposure to inhalation anaesthesia (HR=1.12; 95% confidence interval [CI], 1.02-1.23). The HR estimates for all-cause mortality and disease-free survival were 1.00 (95% CI, 0.93-1.07) and 1.04 (95% CI, 0.98-1.11) respectively.
Exposure to inhalation anaesthesia was associated with increased risk of recurrence after colorectal cancer surgery.
在结直肠癌手术中，吸入麻醉的免疫调节作用可能为转移形成创造有利环境，从而增加复发风险。我们的目的是评估吸入麻醉与静脉麻醉在接受结直肠癌手术的患者中的癌症复发与复发之间的关系。
在丹麦结直肠癌组数据库和丹麦麻醉数据库中确定了 2004-18 年间接受结直肠癌手术的患者。在排除术后病理报告中记录的残留肿瘤、局部内镜切除和支架插入的患者后，我们根据暴露于吸入麻醉的情况对患者进行分类。主要结局是复发（复发时间），次要结局是全因死亡率（死亡时间）和无病生存率（复发或死亡时间）。复发和死亡事件通过丹麦民事登记系统、丹麦国家病理登记处和丹麦国家患者登记处确定。使用亚分布风险方法估计复发的风险比（HR），并使用 Cox 回归分析全因死亡率和无病生存率。
我们确定了 5238 例暴露于吸入麻醉和 6322 例暴露于静脉麻醉的患者。倾向评分匹配产生了每组 4347 名具有平衡基线协变量的个体。我们发现复发与暴露于吸入麻醉之间存在弱关联（HR=1.12；95%置信区间 [CI]，1.02-1.23）。全因死亡率和无病生存率的 HR 估计值分别为 1.00（95%CI，0.93-1.07）和 1.04（95%CI，0.98-1.11）。
暴露于吸入麻醉与结直肠癌手术后复发风险增加相关。
