Propofol TIVA may be associated with improved survival after colon cancer surgery when compared with desflurane inhalation anaesthesia.

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• Zhi-Fu Wu, Meei-Shyuan Lee, Chih-Shung Wong, Chueng-He Lu, Yuan-Shiou Huang, Kuen-Tze Lin, Yu-Sheng Lou, Chin Lin, Yue-Cune Chang, and Hou-Chuan Lai.
• From the Departments of Anesthesiology (Z.-F.W., C.-H.L., Y.-S.H., H.-C.L.) Radiation Oncology (K.-T.L.), Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China the School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China (M.-S.L., Y.-S.L., C.L.) the Division of Anesthesiology, Cathay General Hospital, Taipei, Taiwan, Republic of China (C.-S.W.) the Department of Mathematics, Tamkang University, New Taipei City, Taiwan, Republic of China (Y.-C.C.).
• Anesthesiology. 2018 Nov 1; 129 (5): 932-941.

What We Already Know About This TopicWHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Previous research has shown different effects of anesthetics on cancer cell growth. Here, the authors investigated the association between type of anesthetic and patient survival after elective colon cancer surgery.MethodsA retrospective cohort study included patients who received elective colon cancer surgery between January 2005 and December 2014. Patients were grouped according to anesthesia received: propofol or desflurane. After exclusion of those who received combined propofol anesthesia with inhalation anesthesia or epidural anesthesia, survival curves were constructed from the date of surgery to death. After propensity matching, univariable and multivariable Cox regression models were used to compare hazard ratios for death. Subgroup analyses were performed for tumor-node-metastasis staging and postoperative metastasis.ResultsA total of 706 patients (307 deaths, 43.5%) with desflurane anesthesia and 657 (88 deaths, 13.4%) with propofol anesthesia were eligible for analysis. After propensity matching, 579 patients remained in each group (189 deaths, 32.6%, in the desflurane group vs. 87, 15.0%, in the propofol group). In the matched analyses, the propofol-treated group had a better survival, irrespective of lower tumor-node-metastasis stage (hazard ratio, 0.22; 95% CI, 0.11 to 0.42; P < 0.001) or higher tumor-node-metastasis stage (hazard ratio, 0.42; 95% CI, 0.32 to 0.55; P < 0.001) and presence of metastases (hazard ratio, 0.67; 95% CI, 0.51 to 0.86; P = 0.002) or absence of metastases (hazard ratio, 0.08; 95% CI, 0.01 to 0.62; P = 0.016). Simple propensity score adjustment produced similar findings.ConclusionsPropofol anesthesia for colon cancer surgery is associated with better survival irrespective of tumor-node-metastasis stage.

This article appears in the collection: Anesthesia technique and cancer recurrence.

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