• Shuang-Jie Cao, Yue Zhang, Yu-Xiu Zhang, Wei Zhao, Ling-Hui Pan, Xu-De Sun, Zhen Jia, Wen Ouyang, Qing-Shan Ye, Fang-Xiang Zhang, Yong-Qing Guo, Yan-Qiu Ai, Bin-Jiang Zhao, Jian-Bo Yu, Zhi-Heng Liu, Ning Yin, Xue-Ying Li, Jia-Hui Ma, Hui-Juan Li, Mei-Rong Wang, Daniel I Sessler, Daqing Ma, Dong-Xin Wang, and First Study of Perioperative Organ Protection (SPOP1) investigators.
• Department of Anesthesiology, Peking University First Hospital, Beijing, China.
• Br J Anaesth. 2023 Aug 1; 131 (2): 266275266-275.

BackgroundExperimental evidence indicates that i.v. anaesthesia might reduce cancer recurrence compared with volatile anaesthesia, but clinical information is observational only. We therefore tested the primary hypothesis that propofol-based anaesthesia improves survival over 3 or more years after potentially curative major cancer surgery.MethodsThis was a long-term follow-up of a multicentre randomised trial in 14 tertiary hospitals in China. We enrolled 1228 patients aged 65-90 yr who were scheduled for major cancer surgery. They were randomised to either propofol-based i.v. anaesthesia or to sevoflurane-based inhalational anaesthesia. The primary endpoint was overall survival after surgery. Secondary endpoints included recurrence-free and event-free survival.ResultsAmongst subjects randomised, 1195 (mean age 72 yr; 773 [65%] male) were included in the modified intention-to-treat analysis. At the end of follow-up (median 43 months), there were 188 deaths amongst 598 patients (31%) assigned to propofol-based anaesthesia compared with 175 deaths amongst 597 patients (29%) assigned to sevoflurane-based anaesthesia; adjusted hazard ratio 1.02; 95% confidence interval (CI): 0.83-1.26; P=0.834. Recurrence-free survival was 223/598 (37%) in patients given propofol anaesthesia vs 206/597 (35%) given sevoflurane anaesthesia; adjusted hazard ratio 1.07; 95% CI: 0.89-1.30; P=0.465. Event-free survival was 294/598 (49%) in patients given propofol anaesthesia vs 274/597 (46%) given sevoflurane anaesthesia; adjusted hazard ratio 1.09; 95% CI 0.93 to 1.29; P=0.298.ConclusionsLong-term survival after major cancer surgery was similar with i.v. and volatile anaesthesia. Propofol-based iv. anaesthesia should not be used for cancer surgery with the expectation that it will improve overall or cancer-specific survival.Clinical Trial RegistrationsChiCTR-IPR-15006209; NCT02660411.Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.

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