• Sarah de La Motte Watson, Kathryn Puxty, Daisy Moran, David S Morrison, Billy Sloan, Donal Buggy, and Ben Shelley.
• University of Glasgow, Glasgow, UK.
• J. Cardiothorac. Vasc. Anesth. 2021 Nov 1; 35 (11): 3265-3274.

ObjectivesBecause of the biologic effects of volatile anesthetics on the immune system and cancer cells, it has been hypothesized that their use during non-small cell lung cancer (NSCLC) surgery may negatively affect cancer outcomes compared with total intravenous anesthesia (TIVA) with propofol. The present study evaluated the relationship between anesthetic technique and dose and oncologic outcome in NSCLC surgery.DesignRetrospective cohort study.SettingSurgical records collated from a single, tertiary care hospital and combined with the Scottish Cancer Registry and continuously recorded electronic anesthetic data.ParticipantsPatients undergoing elective lung resection for NSCLC between January 2010 and December 2014.InterventionsThe cohort was divided into patients receiving TIVA only and patients exposed to volatile anesthetics.Measurements And Main ResultsFinal analysis included 746 patients (342 received TIVA and 404 volatile anesthetic). Kaplan-Meier survival curves with log-rank testing were drawn for cancer-specific and overall survival. No significant differences were demonstrated for either cancer-specific (p = 0.802) or overall survival (p = 0.736). Factors influencing survival were analyzed using Cox proportional hazards modeling. Anesthetic type was not a significant predictor for cancer-specific or overall survival in univariate or multivariate Cox analysis. Volatile anesthetic exposure was quantified using area under the end-tidal expired anesthetic agent versus time curves. This was not significantly associated with cancer-specific survival on univariate (p = 0.357) or multivariate (p = 0.673) modeling.ConclusionsNo significant relationship was demonstrated between anesthetic technique and NSCLC survival. Whether a causal relationship exists between anesthetic technique during NSCLC surgery and oncologic outcome warrants definitive investigation in a prospective, randomized trial.Copyright © 2021 Elsevier Inc. All rights reserved.

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