Impact of anesthetic agents on overall and recurrence-free survival in patients undergoing esophageal cancer surgery: A retrospective observational study

Abstract

Given that surgical stress response and surgical excision may increase the likelihood of post-surgery cancer dissemination and metastasis, the appropriate choice of surgical anesthetics may be important for oncologic outcomes. We evaluated the association of anesthetics used for general anesthesia with overall survival and recurrence-free survival in patients who underwent esophageal cancer surgery. Adult patients (922) underwent elective esophageal cancer surgery were included. The patients were divided into two groups according to the anesthetics administered during surgery: volatile anesthesia (VA) or intravenous anesthesia with propofol (TIVA). Propensity score and Cox regression analyses were performed. There were 191 patients in the VA group and 731 in the TIVA group. In the entire cohort, VA was independently associated with worse overall survival (HR 1.58; 95% CI 1.24-2.01; P < 0.001) and recurrence-free survival (HR 1.42; 95% CI 1.12-1.79; P = 0.003) after multivariable analysis adjustment. Similarly, in the propensity score matched cohorts, VA was associated with worse overall survival (HR 1.45; 95% CI 1.11-1.89; P = 0.006) and recurrence-free survival (HR 1.44; 95% CI 1.11-1.87; P = 0.006). TIVA during esophageal cancer surgery was associated with better postoperative survival rates compared with volatile anesthesia.

Figure 1

Study flow diagram. SCC = squamous cell carcinoma.

Figure 2

Kaplan-Meier overall survival curves from the date of esophageal cancer surgery by anesthesia type in the total cohort (A) and the propensity matched cohort (B).

Figure 3

Kaplan-Meier recurrence-free survival curves from the date of esophageal cancer surgery by anesthesia type in the total cohort (A) and the propensity matched cohort (B).