Newly Published
Perioperative Medicine  |   October 2018
Total Intravenous Anesthesia versus Inhalation Anesthesia for Breast Cancer Surgery: A Retrospective Cohort Study
Author Notes
  • From the Departments of Anesthesiology and Pain Medicine (S.Y., S.-K.P., W.H.K., J.-T.K.), and Surgery (H.-B.L., W.H., D.-Y.N.), Seoul National University Hospital; and the Cancer Research Institute (H.-B.L., W.H., D.-Y.N.), Seoul National University, Seoul, Korea.
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication April 30, 2018. Accepted for publication September 27, 2018.
    Submitted for publication April 30, 2018. Accepted for publication September 27, 2018.×
  • Correspondence: Address correspondence to Dr. Kim: Seoul National University Hospital, Daehak-ro 101, Jongno-gu, Seoul, 03080, Korea. jintae73@gmail.com. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Pharmacology / Respiratory System / Technology / Equipment / Monitoring / Opioid
Perioperative Medicine   |   October 2018
Total Intravenous Anesthesia versus Inhalation Anesthesia for Breast Cancer Surgery: A Retrospective Cohort Study
Anesthesiology Newly Published on October 29, 2018. doi:10.1097/ALN.0000000000002491
Anesthesiology Newly Published on October 29, 2018. doi:10.1097/ALN.0000000000002491
Abstract

Editor’s Perspective:

What We Know about This Topic:

  • IV anesthesia may impair anticancer immunity less than volatile anesthesia and therefore reduce recurrence risk

What This Article Tells Us That Is New:

  • In a large propensity-matched retrospective cohort analysis, the authors compared total IV and volatile anesthesia for breast cancer surgery

  • Recurrence hazard was similar with each approach

  • Selection of IV or volatile anesthesia should be based on factors other than cancer recurrence

Background:: The association between type of anesthesia used and recurrence of cancer remains controversial. This retrospective cohort study compared the influence of total IV anesthesia and inhalation anesthesia on the primary outcome of recurrence-free survival after breast cancer surgery.

Methods:: The authors reviewed the electronic medical records of patients who had breast cancer surgery at a tertiary care teaching hospital between January 2005 and December 2013. The patients were grouped according to whether IV or inhalation anesthesia was used for surgery. Propensity score matching was used to account for differences in baseline characteristics. Kaplan–Meier survival curves were constructed to evaluate the influence of type of anesthesia on recurrence-free survival and overall survival. The risks of cancer recurrence and all-cause mortality were compared between each type of anesthesia.

Results:: Of 7,678 patients who had breast cancer surgery during the study period, data for 5,331 patients were available for analysis (IV group, n = 3,085; inhalation group, n = 2,246). After propensity score matching, 1,766 patients remained in each group. Kaplan–Meier survival curves showed that there was no significant difference in recurrence-free survival or overall survival between the two groups, with 5-yr recurrence-free survival rates of 93.2% (95% CI, 91.9 to 94.5) in the IV group and 93.8% (95% CI, 92.6 to 95.1) in the inhalation group. Inhalation anesthesia had no significant impact on recurrence-free survival (hazard ratio, 0.96; 95% CI, 0.69 to 1.32; P = 0.782) or overall survival (hazard ratio, 0.96; 95% CI, 0.69 to 1.33, P = 0.805) when compared with total IV anesthesia.

Conclusions:: The authors found no association between type of anesthesia used and the long-term prognosis of breast cancer. The results of this retrospective cohort study do not suggest specific selection of IV or inhalation anesthesia for breast cancer surgery.