Kwon Ji-Hye, Kim Jeayoun, Yeo Hyean, Kim Keoungah, Rhu Jinsoo, Choi Gyu-Seong, Kim Jongman, Joh Jae-Won, Kim Kyunga, Kim Min-Ji, Jeong Ji Seon, Lee Jong-Hwan, Han Sangbin, Ko Justin S, Gwak Mi Sook, Kim Gaab Soo
Department of Anaesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Anaesthesia and Pain Medicine, CHA Ilsan Medical Centre, CHA University, Ilsan, Gyeonggi-do, South Korea.
Anaesthesia. 2025 Apr;80(4):366-377. doi: 10.1111/anae.16488. Epub 2025 Jan 8.
While evidence from preclinical and observational cohort studies have suggested potential disparities in tumour behaviour associated with the choice of intra-operative anaesthetics, clinical evidence of tumour recurrence and metastasis remains inconclusive. We aimed to compare the impact of intra-operative anaesthesia on oncologic outcomes following hepatectomy for hepatocellular carcinoma.
Adult patients scheduled for elective hepatectomy for hepatocellular carcinoma were assigned randomly (1:1) to either propofol-based total intravenous anaesthesia or sevoflurane-based inhalational anaesthesia. For recurrence-free survival, overall survival, intrahepatic recurrence-free survival and extrahepatic recurrence-free survival, the survival curves of the two groups were estimated using the Kaplan-Meier method and compared with the log-rank test. The primary outcome was one-year recurrence-free survival.
Among the 536 patients enrolled, primary analysis comprised 228 and 226 patients in the total intravenous anaesthesia and sevoflurane-based inhalational anaesthesia groups, respectively. The probability of recurrence-free survival at one year was 79.1% (47 events) and 77.7% (50 events) in the total intravenous anaesthesia and sevoflurane-based inhalational anaesthesia groups, respectively (adjusted hazard ratio 1.04, 95%CI 0.72-1.52). The probability of intrahepatic and extrahepatic recurrence-free survival, as well as overall survival at one year, was not significantly different between total intravenous anaesthesia and sevoflurane-based inhalational anaesthesia: 81.3% (42 events) vs. 81.7% (41 events); 91.5% (19 events) vs. 88.8% (25 events); 99.1% (2 events) vs. 100.0% (no event), respectively. Subgroup analyses revealed that in patients undergoing open hepatectomy, total intravenous anaesthesia was associated with a significantly lower hazard of tumour recurrence or death (hazard ratio 0.49, 95%CI 0.25-0.95, p = 0.034), while in patients undergoing laparoscopic surgery, no significant difference was observed (hazard ratio 1.14, 95%CI 0.73-1.80, p = 0.558).
Intra-operative anaesthesia technique did not affect postoperative recurrence and overall survival in patients with hepatocellular carcinoma undergoing hepatectomy.
虽然临床前和观察性队列研究的证据表明，术中麻醉剂的选择可能与肿瘤行为存在差异，但肿瘤复发和转移的临床证据仍无定论。我们旨在比较术中麻醉对肝细胞癌肝切除术后肿瘤学结局的影响。
计划接受择期肝细胞癌肝切除术的成年患者被随机（1:1）分配到丙泊酚全静脉麻醉或七氟醚吸入麻醉组。对于无复发生存率、总生存率、肝内无复发生存率和肝外无复发生存率，使用Kaplan-Meier方法估计两组的生存曲线，并通过对数秩检验进行比较。主要结局是一年无复发生存率。
在纳入的536例患者中，初步分析分别包括228例和226例接受全静脉麻醉和七氟醚吸入麻醉的患者。全静脉麻醉组和七氟醚吸入麻醉组一年无复发生存的概率分别为79.1%（47例事件）和77.7%（50例事件）（调整后风险比1.04，95%CI 0.72-1.52）。全静脉麻醉和七氟醚吸入麻醉组之间，肝内和肝外无复发生存概率以及一年总生存率无显著差异：分别为81.3%（42例事件）对81.7%（41例事件）；91.5%（19例事件）对88.8%（25例事件）；99.1%（2例事件）对100.0%（无事件）。亚组分析显示，在接受开放性肝切除术患者中，全静脉麻醉与肿瘤复发或死亡风险显著降低相关（风险比0.49，95%CI 0.25-0.95，p = 0.034），而在接受腹腔镜手术患者中，未观察到显著差异（风险比1.14，95%CI 0.73-1.8即，p = 0.558）。
术中麻醉技术不影响接受肝切除术的肝细胞癌患者的术后复发和总生存率。
