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Comment
. 2019 Aug;123(2):151-160.
doi: 10.1016/j.bja.2019.04.057. Epub 2019 Jun 3.

Propofol-based total intravenous anaesthesia is associated with better survival than desflurane anaesthesia in hepatectomy for hepatocellular carcinoma: a retrospective cohort study

Hou-Chuan Lai  1 , Meei-Shyuan Lee  2 , Chin Lin  2 , Kuen-Tze Lin  3 , Yi-Hsuan Huang  1 , Chih-Shung Wong  4 , Shun-Ming Chan  1 , Zhi-Fu Wu  5
Affiliations
Comment

Propofol-based total intravenous anaesthesia is associated with better survival than desflurane anaesthesia in hepatectomy for hepatocellular carcinoma: a retrospective cohort study

Hou-Chuan Lai et al. Br J Anaesth. 2019 Aug.

Abstract

Background: Previous studies have shown that anaesthetic technique can affect outcomes of cancer surgery. We investigated the association between anaesthetic technique and patient outcomes after elective hepatectomy for hepatocellular carcinoma.

Methods: This was a retrospective single-centre cohort study of patients who received elective hepatectomy for hepatocellular carcinoma from January 2005 to December 2014. Patients were grouped according to propofol or desflurane anaesthesia. Kaplan-Meier analysis was performed and 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 tumour-node-metastasis staging and distant metastasis and local recurrence.

Results: A total of 492 patients (369 deaths, 75.0%) with desflurane anaesthesia and 452 (139 deaths, 30.8%) with propofol anaesthesia were eligible for analysis. After propensity matching, 335 patients remained in each group. In the matched analysis, propofol anaesthesia had a better survival with hazard ratio of 0.47 (95% confidence interval, 0.38-0.59; P<0.001). Subgroup analyses also showed significantly better survival in the absence of distant metastasis (hazard ratio, 0.47; 95% confidence interval, 0.37-0.60; P<0.001) or local recurrence (hazard ratio, 0.22; 95% confidence interval, 0.14-0.34; P<0.001) in the matched groups.

Conclusions: Propofol anaesthesia was associated with better survival in hepatocellular carcinoma patients who underwent hepatectomy. Prospective studies are warranted to evaluate the effects of propofol anaesthesia on surgical outcomes in hepatocellular carcinoma patients.

Keywords: cancer surgery; desflurane; hepatectomy; hepatocellular carcinoma; outcomes; propofol; survival.

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Conflict of interest statement

The authors declare that they have no conflict of interests.

Figures

Fig 1
Fig 1
Flow diagram detailing the selection of patients included in the retrospective analysis. 70 patients were excluded because of combined propofol anaesthesia with inhalation anaesthesia or regional analgesia, incomplete data, age <20 yr, or undergoing liver transplantation.
Fig 2
Fig 2
(a) Overall survival curves from the date of surgery by anaesthesia type. (b) Overall survival curves from the date of surgery by presence (or not) of metastasis. (c) Overall survival curves from the date of surgery by presence (or not) of recurrence. MET, metastasis.
See this image and copyright information in PMC

Comment on

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