Propofol-based intravenous anesthesia is associated with better survival than desflurane anesthesia in pancreatic cancer surgery.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2020
2020
Historique:
received:
02
08
2019
accepted:
10
05
2020
entrez:
22
5
2020
pubmed:
22
5
2020
medline:
12
8
2020
Statut:
epublish
Résumé
Previous researches have shown that anesthetic techniques can influence the patient outcomes of cancer surgery. Here, we studied the relationship between type of anesthetic and patient outcomes following elective, open pancreatic cancer surgery. This was a retrospective cohort study of patients who received elective, open pancreatic cancer surgery between January 2005 and July 2018. Patients were grouped according to the anesthesia they received, namely desflurane or propofol. A Kaplan-Meier analysis was conducted, and survival curves were presented from the date of surgery to death. Univariable and multivariable Cox regression models were used to compare hazard ratios for death after propensity matching. Subgroup analyses were performed for all-cause mortality, cancer-specific mortality, and disease progression. A total of 68 patients (56 deaths, 82.0%) under desflurane anesthesia, and 72 patients (43 deaths, 60.0%) under propofol anesthesia were included. Fifty-eight patients remained in each group after propensity matching. The propofol anesthesia was associated with improved survival (hazard ratio, 0.65; 95% confidence interval, 0.42-0.99; P = 0.047) in the matched analysis. Subgroup analyses showed significantly better cancer-specific survival (hazard ratio, 0.63; 95% confidence interval, 0.40-0.97; P = 0.037) in the propofol group. Additionally, patients under propofol had less postoperative recurrence, but not fewer postoperative metastases formation, than those under desflurane (hazard ratio, 0.55; 95% confidence interval, 0.34-0.90; P = 0.028) in the matched analysis. In a limited sample size, we observed that propofol anesthesia was associated with improved survival in open pancreatic cancer surgery compared with desflurane anesthesia. Further investigations are needed to inspect the influences of propofol anesthesia on patient outcomes of pancreatic cancer surgery.
Sections du résumé
BACKGROUND
Previous researches have shown that anesthetic techniques can influence the patient outcomes of cancer surgery. Here, we studied the relationship between type of anesthetic and patient outcomes following elective, open pancreatic cancer surgery.
METHODS
This was a retrospective cohort study of patients who received elective, open pancreatic cancer surgery between January 2005 and July 2018. Patients were grouped according to the anesthesia they received, namely desflurane or propofol. A Kaplan-Meier analysis was conducted, and survival curves were presented from the date of surgery to death. Univariable and multivariable Cox regression models were used to compare hazard ratios for death after propensity matching. Subgroup analyses were performed for all-cause mortality, cancer-specific mortality, and disease progression.
RESULTS
A total of 68 patients (56 deaths, 82.0%) under desflurane anesthesia, and 72 patients (43 deaths, 60.0%) under propofol anesthesia were included. Fifty-eight patients remained in each group after propensity matching. The propofol anesthesia was associated with improved survival (hazard ratio, 0.65; 95% confidence interval, 0.42-0.99; P = 0.047) in the matched analysis. Subgroup analyses showed significantly better cancer-specific survival (hazard ratio, 0.63; 95% confidence interval, 0.40-0.97; P = 0.037) in the propofol group. Additionally, patients under propofol had less postoperative recurrence, but not fewer postoperative metastases formation, than those under desflurane (hazard ratio, 0.55; 95% confidence interval, 0.34-0.90; P = 0.028) in the matched analysis.
CONCLUSIONS
In a limited sample size, we observed that propofol anesthesia was associated with improved survival in open pancreatic cancer surgery compared with desflurane anesthesia. Further investigations are needed to inspect the influences of propofol anesthesia on patient outcomes of pancreatic cancer surgery.
Identifiants
pubmed: 32437450
doi: 10.1371/journal.pone.0233598
pii: PONE-D-19-21803
pmc: PMC7241788
doi:
Substances chimiques
Anesthetics, Inhalation
0
Anesthetics, Intravenous
0
Desflurane
CRS35BZ94Q
Propofol
YI7VU623SF
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0233598Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Medicine (Baltimore). 2019 Dec;98(51):e18472
pubmed: 31861027
Br J Cancer. 2014 Sep 23;111(7):1338-49
pubmed: 25072260
Anaesthesia. 2004 Oct;59(10):954-9
pubmed: 15488052
Eur J Pharmacol. 2017 Jan 15;795:150-159
pubmed: 27986626
Basic Clin Pharmacol Toxicol. 2019 Sep;125(3):271-278
pubmed: 30861616
Anesthesiology. 2015 Feb;122(2):317-24
pubmed: 25305092
Anesth Analg. 2003 Nov;97(5):1331-9
pubmed: 14570648
Am J Cancer Res. 2017 Feb 01;7(2):357-369
pubmed: 28337383
Zhonghua Yi Xue Za Zhi. 2017 Jun 13;97(22):1719-1723
pubmed: 28606281
PLoS One. 2019 Nov 7;14(11):e0224728
pubmed: 31697743
Ups J Med Sci. 2014 Aug;119(3):251-61
pubmed: 24857018
Am J Pathol. 2010 May;176(5):2292-301
pubmed: 20363910
Surgery. 2015 May;157(5):881-7
pubmed: 25704415
PLoS One. 2020 Mar 17;15(3):e0230290
pubmed: 32182262
Cancer Res. 1999 Nov 15;59(22):5830-5
pubmed: 10582706
Anesth Pain Med. 2017 Aug 21;7(4):e13879
pubmed: 29344445
Br J Anaesth. 2008 Dec;101(6):781-7
pubmed: 18922851
J Clin Invest. 1981 Sep;68(3):678-85
pubmed: 7276167
Am J Transl Res. 2016 Oct 15;8(10):4120-4133
pubmed: 27829997
Surgery. 2014 Jan;155(1):39-46
pubmed: 23890963
Anesthesiology. 2016 Jan;124(1):69-79
pubmed: 26556730
Am Fam Physician. 2014 Apr 15;89(8):626-32
pubmed: 24784121
HPB (Oxford). 2017 Feb;19(2):83-92
pubmed: 28065427
Genet Mol Res. 2015 Jul 06;14(3):7529-37
pubmed: 26214431
J Am Coll Cardiol. 2002 Feb 6;39(3):542-53
pubmed: 11823097
Transplant Proc. 2008 May;40(4):1195-9
pubmed: 18555147
Sci Rep. 2017 Oct 25;7(1):14020
pubmed: 29070852
Korean J Anesthesiol. 2016 Apr;69(2):126-32
pubmed: 27066202
Anesthesiology. 2018 Nov;129(5):932-941
pubmed: 30028726
Anesthesiology. 2013 Sep;119(3):593-605
pubmed: 23774231
J Control Release. 2019 Jun 28;304:204-215
pubmed: 31100311
Br J Anaesth. 2019 Aug;123(2):151-160
pubmed: 31171343
Immunopharmacol Immunotoxicol. 2007;29(3-4):477-86
pubmed: 18075859
J Gastrointest Oncol. 2012 Jun;3(2):105-19
pubmed: 22811878
Cancer Lett. 2002 Oct 28;184(2):165-70
pubmed: 12127688
Br J Anaesth. 2010 Aug;105(2):106-15
pubmed: 20627881
Can J Anaesth. 1997 Jan;44(1):90-4
pubmed: 8988831
Gut. 1987 May;28(5):527-32
pubmed: 3596334
Oncotarget. 2017 Apr 11;8(15):25242-25250
pubmed: 28445955
Anesthesiology. 2005 Jun;102(6):1147-57
pubmed: 15915027
Ann Surg Oncol. 2018 Dec;25(13):4020-4026
pubmed: 30298316
Can J Anaesth. 2009 Mar;56(3):222-9
pubmed: 19247743
Anesth Analg. 1997 Dec;85(6):1394-8
pubmed: 9390615
Eur J Surg Oncol. 2019 Oct;45(10):1770-1777
pubmed: 31204168