Enlund Anna, Nikberg Maziar, Berglund Anders, Östberg Erland, Enlund Mats
Department of Anaesthesia and Intensive Care, Vastmanland Hospital, Vasteras, Sweden.
Centre for Clinical Research, Uppsala University, Vastmanland Hospital, Vasteras, Sweden.
Anaesthesia. 2025 Apr;80(4):386-394. doi: 10.1111/anae.16495. Epub 2024 Dec 16.
Retrospective studies suggest that inhalational volatile anaesthetic agents may contribute to an increased risk of metastasis and reduction in survival rates when used during cancer surgery. This relationship may vary between cancer types due to different tumour biology and differences in surgical procedures. This study aimed to investigate the relationship between the type of anaesthetic used for maintenance of anaesthesia (propofol or inhalational volatile anaesthetic agent) and survival in patients with stage 1-3 colorectal cancer who underwent resection surgery under general anaesthesia in Sweden between 2014 and 2019.
We identified patients from the Swedish Colorectal Cancer Registry. Their data, including cancer characteristics and adjuvant treatment, were then merged with information from the Swedish Peri-operative Registry. The primary outcome was overall survival, with disease-free survival as a secondary outcome.
Of the 11,598 patients included, 8161 had colon cancer and 3437 had rectal cancer. General anaesthesia was maintained with propofol in 2346 (20%) patients, while 9252 (80%) received an inhalational volatile anaesthetic agent. In the unmatched cohort, patients who had general anaesthesia maintained with propofol for colon cancer surgery showed improved survival compared with those receiving an inhalational volatile anaesthetic agent (hazard ratio 0.83, 95%CI 0.72-0.95, p = 0.008). After 1:2 propensity score matching, we observed no significant difference in survival rates in this group (hazard ratio 0.89, 95%CI 0.76-1.04, p = 0.127). In the rectal cancer group, there was no difference in survival in either the unmatched cohort (hazard ratio 0.83, 95%CI 0.65-1.08, p = 0.166) or after propensity score matching (hazard ratio 0.95, 95%CI 0.71-1.25, p = 0.702). There was no significant difference in disease-free survival in either type of cancer.
We found no association between the choice of agent for maintenance of anaesthesia and long-term survival outcomes in patients with colorectal cancer.
回顾性研究表明，吸入性挥发性麻醉剂在癌症手术中使用时，可能会增加转移风险并降低生存率。由于不同的肿瘤生物学特性和手术程序的差异，这种关系在不同癌症类型之间可能有所不同。本研究旨在调查2014年至2019年期间在瑞典接受全身麻醉下切除手术的1-3期结直肠癌患者中，用于维持麻醉的麻醉剂类型（丙泊酚或吸入性挥发性麻醉剂）与生存率之间的关系。
我们从瑞典结直肠癌登记处识别出患者。然后将他们的数据，包括癌症特征和辅助治疗，与瑞典围手术期登记处的信息合并。主要结局是总生存期，无病生存期作为次要结局。
在纳入的11598例患者中，8161例患有结肠癌，3437例患有直肠癌。2346例（20%）患者使用丙泊酚维持全身麻醉，而9252例（80%）接受吸入性挥发性麻醉剂。在未匹配的队列中，结肠癌手术使用丙泊酚维持全身麻醉的患者与接受吸入性挥发性麻醉剂的患者相比，生存率有所提高（风险比0.83，95%置信区间0.72-0.95，p = 0.008）。在1:2倾向评分匹配后，我们在该组中未观察到生存率的显著差异（风险比0.89，95%置信区间0.76-1.04，p = 0.127）。在直肠癌组中，未匹配队列（风险比0.83，95%置信区间0.65-1.08，p = 0.166）或倾向评分匹配后（风险比0.95，95%置信区间0.71-1.25，p = 0.702）的生存率均无差异。两种癌症类型的无病生存期均无显著差异。
我们发现结直肠癌患者麻醉维持药物的选择与长期生存结局之间没有关联。
