Effects of propofol-based total intravenous anesthesia on gastric cancer: a retrospective study
Authors Zheng XY, Wang Y, Dong LL, Zhao S, Wang LP, Chen H, Xu Y, Wang GN
Received 11 November 2017
Accepted for publication 5 January 2018
Published 1 March 2018 Volume 2018:11 Pages 1141—1148
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 2
Editor who approved publication: Dr Tohru Yamada
Xiaoyu Zheng,1 Yu Wang,1 Linlin Dong,1 Su Zhao,2 Liping Wang,1 Hong Chen,1 Yang Xu,1 Guonian Wang1
1Department of Anesthesiology, Harbin Medical University Cancer Hospital, Harbin, China; 2Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, China
Background: Several kinds of cancer surgeries with propofol-based total intravenous anesthesia (TIVA) have been shown to have better outcomes than those with sevoflurane-based inhalational anesthesia (INHA). However, the effects of this anesthetic technique have not been investigated in patients with gastric cancer. In this study, the authors retrospectively examined the link between the choice of anesthetic technique and overall survival in patients undergoing gastric cancer resection.
Methods: We conducted a retrospective analysis of the database of all patients undergoing gastric cancer resection for gastric cancer between 2007 and 2012. Patients who received TIVA or INHA were administered patient-controlled intravenous analgesia for 72–120 hours postoperatively. Survival was estimated using the Kaplan–Meier log-rank test, and associations between anesthetic technique and outcomes were analyzed using Cox proportional hazards regressions after propensity matching.
Results: A total of 2,856 anesthetics using INHA or TIVA were delivered in the study period. After propensity matching, 897 patients remained in each group. According to Kaplan–Meier analysis, the use of TIVA was associated with improved survival (P<0.001). TIVA was associated with a hazard ratio (HR) of 0.67 (95% confidence interval [CI]: 0.58–0.77) for death in univariate analysis and 0.65 (95% CI: 0.56–0.75) after a multivariate analysis of known confounders in the matched group. Cancer stage (HR =0.74, 95% CI: 0.64–0.86, P<0.001) and degree of differentiation (HR =1.28, 95% CI: 1.11–1.47, P<0.001) were also associated with survival in the univariate analysis in the matched group. In the multivariable Cox model, cancer stage (HR =0.72, 95% CI: 0.62–0.84, P<0.001) and degree of differentiation (HR =1.23, 95% CI: 1.07–1.42, P<0.001) were associated with survival in the matched group.
Conclusion: These results indicate that TIVA may be associated with improved survival in gastric cancer patients who undergo resection.
Keywords: anesthesia, propofol, sevoflurane, patient-controlled analgesia, gastric cancer, overall survival
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