Department of Anesthesiology, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
Medicine (Baltimore). 2022 Jul 22;101(29):e29169. doi: 10.1097/MD.0000000000029169.
The surgical stress responses, surgeries, and anesthetics used during surgeries have effects on post-surgery complications and metastasis. Volatile and/or intravenous anesthetics are generally used for cancer curative surgeries. Therefore, appropriate selection of anesthetics should be considered for better clinical outcomes. The objectives of the study were to compare postoperative complications, the overall survival, and recurrence-free survival of patients who had received volatile anesthesia against those of patients who had received propofol-based total intravenous anesthesia for digestive tract cancer curative surgeries. Patients had received propofol-based total intravenous anesthesia (PA cohort, n = 120) or volatile anesthesia (VA cohort, n = 185) for elective digestive tract cancer curative surgeries. Patients with age > 50 years (P = .0399), body mass index ≥ 25 kg/m2 (P = .0423), cancer stage III (P = .0041), and cancer stage IV (P = .0189) were operated through volatile anesthesia. Females (P = .0346), disable patients (P = .0479), patients with Charlson Comorbidity Index 2 (P = .0449), patients with cancer stage 0 or I (P = .0141), and patients with cancer stage II (P = .0289) were operated through propofol-based total intravenous anesthesia. Postoperative complication(s) between patients of both cohorts were statistically same (P = .9217). After 3-years of the follow-up period, a total of 81 (44%) patients from the VA cohort and 63 (52%) patients from the PA cohort survived irrespective of any kind of disease(s) (P = .9918). Also, a total of 53 (29%) patients from the VA cohort and 42 (35%) patients from the PA cohort survived without progression of cancer (P = .9981) after 3-years. Age > 50 years (P = 0.0491), Charlson Comorbidity Index ≥ 3 (P = 0.0481), and cancer stage > II (P = .0412) were independent parameters for death of patients suffering from digestive tract cancer due to any reason(s) during 3-years of the follow-up period after surgeries. The selection of anesthetic agents for cancer curative surgeries does not affect survival during 3-years of follow-up and postoperative complication(s) of patients suffering from digestive tract cancer (Level of Evidence: III; Technical Efficacy Stage: 4).
手术应激反应、手术本身以及术中使用的麻醉剂会影响术后并发症和转移。挥发性和/或静脉麻醉剂通常用于癌症根治性手术。因此，为了获得更好的临床结果，应考虑选择合适的麻醉剂。本研究的目的是比较接受挥发性麻醉的患者与接受依托咪酯全凭静脉麻醉的患者在消化道癌症根治性手术后的术后并发症、总生存率和无复发生存率。患者接受依托咪酯全凭静脉麻醉（PA 队列，n = 120）或挥发性麻醉（VA 队列，n = 185）进行择期消化道癌症根治性手术。年龄 > 50 岁（P =.0399）、体重指数 ≥ 25 kg/m2（P =.0423）、癌症 III 期（P =.0041）和癌症 IV 期（P =.0189）的患者接受挥发性麻醉。女性（P =.0346）、残疾患者（P =.0479）、Charlson 合并症指数 2 患者（P =.0449）、癌症 0 期或 I 期患者（P =.0141）和癌症 II 期患者（P =.0289）接受依托咪酯全凭静脉麻醉。两组患者的术后并发症（P =.9217）无统计学差异。在 3 年的随访期后，VA 队列中有 81 名（44%）患者和 PA 队列中有 63 名（52%）患者无论有无任何疾病均存活（P =.9918）。此外，在 3 年的随访期后，VA 队列中有 53 名（29%）患者和 PA 队列中有 42 名（35%）患者无癌症进展（P =.9981）。年龄 > 50 岁（P = 0.0491）、Charlson 合并症指数 ≥ 3（P = 0.0481）和癌症期 > II 期（P =.0412）是 3 年内手术治疗后因任何原因死亡的消化道癌症患者的独立参数。癌症根治性手术中麻醉剂的选择不影响 3 年随访期间患者的生存和消化道癌症患者的术后并发症（证据水平：III；技术功效阶段：4）。
