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

June 4, 2023

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 65e90 yr who were scheduled for major cancer surgery. They were randomised to either propofol- based 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-to- treat 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): 0.83e1.26; P¼0.834. 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: 0.89e1.30; P¼0.465. 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; P¼0.298.
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.
Keywords:
Aged; cancer surgery; inhalation anaesthesia; intravenous anaesthesia; morbidity; propofol; sevoflurane; survival