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. 2018 Mar 1:11:1141-1148.
doi: 10.2147/OTT.S156792. eCollection 2018.

Effects of propofol-based total intravenous anesthesia on gastric cancer: a retrospective study

Xiaoyu Zheng  1 , Yu Wang  1 , Linlin Dong  1 , Su Zhao  2 , Liping Wang  1 , Hong Chen  1 , Yang Xu  1 , Guonian Wang  1
Affiliations

Effects of propofol-based total intravenous anesthesia on gastric cancer: a retrospective study

Xiaoyu Zheng et al. Onco Targets Ther. .

Abstract

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; gastric cancer; overall survival; patient-controlled analgesia; propofol; sevoflurane.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Patient identification and exclusion. Abbreviations: INHA, inhalational anesthesia; TIVA, total intravenous anesthesia.
Figure 2
Figure 2
Kaplan–Meier survival curves for patients with TIVA use or INHA use, in matched patients (A) and overall patients (B) (univariate P<0.001*). Abbreviations: INHA, inhalational anesthesia; TIVA, total intravenous anesthesia.
See this image and copyright information in PMC

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