Newly Published
Perioperative Medicine  |   July 2020
Volatile versus Total Intravenous Anesthesia for Cancer Prognosis in Patients Having Digestive Cancer Surgery: A Nationwide Retrospective Cohort Study
Author Notes
  • From the Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo (K.M., H.M., H.Y.); and the Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University (K.F.), Tokyo, Japan.
  • 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 January 9, 2020. Accepted for publication May 29, 2020.
    Submitted for publication January 9, 2020. Accepted for publication May 29, 2020.×
  • Correspondence: Address correspondence to Dr. Makito: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. canakana87@m.u-tokyo.ac.jp. Anesthesiology’s articles are made freely accessible to all readers on www.anesthesiology.org, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Gastrointestinal and Hepatic Systems
Perioperative Medicine   |   July 2020
Volatile versus Total Intravenous Anesthesia for Cancer Prognosis in Patients Having Digestive Cancer Surgery: A Nationwide Retrospective Cohort Study
Anesthesiology Newly Published on July 1, 2020. doi:https://doi.org/10.1097/ALN.0000000000003440
Anesthesiology Newly Published on July 1, 2020. doi:https://doi.org/10.1097/ALN.0000000000003440
Abstract

Background: Previous experimental and clinical studies have shown that anesthetic agents have varying effects on cancer prognosis; however, the results were inconsistent among these studies. The authors compared overall and recurrence-free survival in patients given volatile or intravenous anesthesia for digestive tract cancer surgery.

Methods: The authors selected patients who had elective esophagectomy, gastrectomy, hepatectomy, cholecystectomy, pancreatectomy, colectomy, and rectal cancer surgery from July 2010 to March 2018 using the Japanese Diagnosis Procedure Combination database. Patients were divided into a volatile anesthesia group (desflurane, sevoflurane, or isoflurane with/without nitrous oxide) and a propofol-based total intravenous anesthesia group. The authors hypothesized that total intravenous anesthesia is associated with greater overall and recurrence-free survival than volatile anesthesia. Subgroup analyses were performed for each type of surgery.

Results: The authors identified 196,303 eligible patients (166,966 patients in the volatile anesthesia group and 29,337 patients in the propofol-based total intravenous anesthesia group). The numbers (proportions) of death in the volatile anesthesia and total intravenous anesthesia groups were 17,319 (10.4%) and 3,339 (11.4%), respectively. There were no significant differences between the two groups in overall survival (hazard ratio, 1.02; 95% CI, 0.98 to 1.07; P = 0.28) or recurrence-free survival (hazard ratio, 0.99; 95% CI, 0.96 to 1.03; P = 0.59), whereas instrumental variable analyses showed a slight difference in recurrence-free survival (hazard ratio, 0.92; 95% CI, 0.87 to 0.98; P = 0.01). Subgroup analyses showed no significant difference in overall or recurrence-free survival between the groups in any type of surgery.

Conclusions: Overall and recurrence-free survival were similar between volatile and intravenous anesthesia in patients having digestive tract surgery. Selection of the anesthetic approach for these patients should be based on other factors.

Editor’s Perspective:

What We Already Know about This Topic:

  • Experimental and clinical studies suggest that intravenous anesthesia may reduce cancer recurrence after potentially curative surgery

What This Article Tells Us That Is New:

  • Among more than 190,000 patients who had cancer surgery, overall and recurrence-free survival were comparable in patients who had propofol-based total intravenous and volatile anesthesia

  • Selection of anesthetic approach should be based on factors other than putative effects on cancer recurrence