Long-term survival in older patients given propofol or sevoflurane anaesthesia for major cancer surgery: follow-up of a multicentre randomised trial

被引：24

作者：

Cao, Shuang-Jie ^{[1
]}

Zhang, Yue ^{[1
,2
]}

Zhang, Yu-Xiu ^{[1
]}

Zhao, Wei ^{[3
]}

Pan, Ling -Hui ^{[4
]}

Sun, Xu-De ^{[5
]}

Jia, Zhen ^{[6
]}

Ouyang, Wen ^{[7
]}

Ye, Qing-Shan ^{[8
]}

Zhang, Fang -Xiang ^{[9
]}

Guo, Yong-Qing ^{[10
]}

Ai, Yan-Qiu ^{[11
]}

Zhao, Bin -Jiang ^{[12
]}

Yu, Jian-Bo ^{[13
]}

Liu, Zhi-Heng ^{[14
]}

Yin, Ning ^{[15
,16
]}

Li, Xue-Ying ^{[17
]}

Ma, Jia-Hui ^{[1
]}

Li, Hui -Juan ^{[18
]}

Wang, Mei-Rong ^{[18
]}

Sessler, Daniel I. ^{[19
,21
]}

Ma, Daqing ^{[20
,22
]}

Wang, Dong-Xin ^{[1
,19
]}

机构：

[1] Peking Univ First Hosp, Dept Anesthesiol, Beijing, Peoples R China

[2] Shenzhen Peking Univ Hong Kong Univ Sci & Technol, Clin Res Inst, Shenzhen, Peoples R China

[3] Hebei Med Univ, Dept Anesthesiol, Hosp 4, Shijiazhuang, Hebei, Peoples R China

[4] Guangxi Med Univ, Dept Anesthesiol, Dept Radiat Oncol, Canc Hosp, Nanning, Guangxi Zhuang, Peoples R China

[5] Fourth Mil Med Univ, Air Force Med Univ, Tangdu Hosp, Dept Anesthesiol, Xian, Shaanxi, Peoples R China

[6] Qinghai Univ, Dept Anesthesiol, Affiliated Hosp, Xining, Qinghai, Peoples R China

[7] Cent South Univ, Xiangya Hosp 3, Dept Anesthesiol, Changsha, Hunan, Peoples R China

[8] Peoples Hosp Ningxia Hui Autonomous Reg, Dept Anesthesiol, Yinchuan, Ningxia Hui Aut, Peoples R China

[9] Guizhou Prov Peoples Hosp, Dept Anesthesiol, Guiyang, Guizhou, Peoples R China

[10] Shanxi Prov Peoples Hosp, Dept Anesthesiol, Taiyuan, Shanxi, Peoples R China

[11] Zhengzhou Univ, Dept Anesthesiol Pain & Perioperat Med, Affiliated Hosp 1, Zhengzhou, Henan, Peoples R China

[12] Capital Med Univ, Beijing Shijitan Hosp, Dept Anesthesiol, Beijing, Peoples R China

[13] Tianjin Med Univ, Tianjin Nankai Hosp, Dept Anesthesiol & Crit Care Med, Tianjin, Peoples R China

[14] Shenzhen Univ, Shenzhen Peoples Hosp 2, Hlth Sci Ctr, Dept Anesthesiol,Affiliated Hosp 1, Shenzhen, Guangdong, Peoples R China

[15] Southeast Univ, Zhongda Hosp, Med Sch, Dept Anesthesiol, Nanjing, Jiangsu, Peoples R China

[16] Nanjing Med Univ, Sir Run Run Hosp, Dept Anesthesiol, Nanjing, Jiangsu, Peoples R China

[17] Peking Univ First Hosp, Dept Biostat, Beijing, Peoples R China

[18] Peking Univ, Clin Res Inst, Hlth Sci Ctr, Beijing, Peoples R China

[19] Cleveland Clin, Outcomes Res Consortium, Cleveland, OH 44106 USA

[20] Imperial Coll London, Chelsea & Westminster Hosp, Fac Med, Div Anaesthet Pain Med & Intens Care,Dept Surg &, London, England

[21] Anesthesiol Inst, Dept Outcomes Res, Cleveland, OH USA

[22] Natl Clin Res Ctr Child Hlth, Hangzhou, Peoples R China

来源：

BRITISH JOURNAL OF ANAESTHESIA | 2023年 / 131卷 / 02期

关键词：

aged; cancer surgery; inhalation anaesthesia; intravenous anaesthesia; morbidity; propofol; sevoflurane; survival; TOTAL INTRAVENOUS ANESTHESIA; GENERAL-ANESTHESIA; METASTASIS; VOLATILE; LIFE; ISOFLURANE; QUALITY; PATHWAY;

D O I：

10.1016/j.bja.2023.01.023

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

Background: Experimental 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. Methods: This 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 propofolbased 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. Results: Amongst subjects randomised, 1195 (mean age 72 yr; 773 [65%] male) were included in the modified intention -totreat 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. Conclusions: Long-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 registrations: ChiCTR-IPR-15006209; NCT02660411.

引用

页码：266 / 275

页数：10

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