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The choice of anaesthetic—sevoflurane or propofol—and outcome from cancer surgery: A retrospective analysis

BACKGROUND: Commonly used inhalational hypnotics, such as sevoflurane, are pro-inflammatory, whereas the intravenously administered hypnotic agent propofol is anti-inflammatory and anti-oxidative. A few clinical studies have indicated similar effects in patients. We examined the possible association...

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Autores principales: Enlund, Mats, Berglund, Anders, Andreasson, Kalle, Cicek, Catharina, Enlund, Anna, Bergkvist, Leif
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Informa Healthcare 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4116765/
https://www.ncbi.nlm.nih.gov/pubmed/24857018
http://dx.doi.org/10.3109/03009734.2014.922649
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author Enlund, Mats
Berglund, Anders
Andreasson, Kalle
Cicek, Catharina
Enlund, Anna
Bergkvist, Leif
author_facet Enlund, Mats
Berglund, Anders
Andreasson, Kalle
Cicek, Catharina
Enlund, Anna
Bergkvist, Leif
author_sort Enlund, Mats
collection PubMed
description BACKGROUND: Commonly used inhalational hypnotics, such as sevoflurane, are pro-inflammatory, whereas the intravenously administered hypnotic agent propofol is anti-inflammatory and anti-oxidative. A few clinical studies have indicated similar effects in patients. We examined the possible association between patient survival after radical cancer surgery and the use of sevoflurane or propofol anaesthesia. PATIENTS AND METHODS: Demographic, anaesthetic, and surgical data from 2,838 patients registered for surgery for breast, colon, or rectal cancers were included in a database. This was record-linked to regional clinical quality registers. Cumulative 1- and 5-year overall survival rates were assessed using the Kaplan–Meier method, and estimates were compared between patients given propofol (n = 903) or sevoflurane (n = 1,935). In a second step, Cox proportional hazard models were calculated to assess the risk of death adjusted for potential effect modifiers and confounders. RESULTS: Differences in overall 1- and 5-year survival rates for all three sites combined were 4.7% (p = 0.004) and 5.6% (p < 0.001), respectively, in favour of propofol. The 1-year survival for patients operated for colon cancer was almost 10% higher after propofol anaesthesia. However, after adjustment for several confounders, the observed differences were not statistically significant. CONCLUSION: Propofol anaesthesia might be better in surgery for some cancer types, but the retrospective design of this study, with uneven distributions of several confounders, distorted the picture. These uncertainties emphasize the need for a randomized controlled trial.
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spelling pubmed-41167652014-08-20 The choice of anaesthetic—sevoflurane or propofol—and outcome from cancer surgery: A retrospective analysis Enlund, Mats Berglund, Anders Andreasson, Kalle Cicek, Catharina Enlund, Anna Bergkvist, Leif Ups J Med Sci Original Article BACKGROUND: Commonly used inhalational hypnotics, such as sevoflurane, are pro-inflammatory, whereas the intravenously administered hypnotic agent propofol is anti-inflammatory and anti-oxidative. A few clinical studies have indicated similar effects in patients. We examined the possible association between patient survival after radical cancer surgery and the use of sevoflurane or propofol anaesthesia. PATIENTS AND METHODS: Demographic, anaesthetic, and surgical data from 2,838 patients registered for surgery for breast, colon, or rectal cancers were included in a database. This was record-linked to regional clinical quality registers. Cumulative 1- and 5-year overall survival rates were assessed using the Kaplan–Meier method, and estimates were compared between patients given propofol (n = 903) or sevoflurane (n = 1,935). In a second step, Cox proportional hazard models were calculated to assess the risk of death adjusted for potential effect modifiers and confounders. RESULTS: Differences in overall 1- and 5-year survival rates for all three sites combined were 4.7% (p = 0.004) and 5.6% (p < 0.001), respectively, in favour of propofol. The 1-year survival for patients operated for colon cancer was almost 10% higher after propofol anaesthesia. However, after adjustment for several confounders, the observed differences were not statistically significant. CONCLUSION: Propofol anaesthesia might be better in surgery for some cancer types, but the retrospective design of this study, with uneven distributions of several confounders, distorted the picture. These uncertainties emphasize the need for a randomized controlled trial. Informa Healthcare 2014-08 2014-07-14 /pmc/articles/PMC4116765/ /pubmed/24857018 http://dx.doi.org/10.3109/03009734.2014.922649 Text en © Informa Healthcare http://creativecommons.org/licenses/by-nc-nd/3.0/ This is an open-access article distributed under the terms of the CC-BY-NC-ND 3.0 License which permits users to download and share the article for non-commercial purposes, so long as the article is reproduced in the whole without changes, and provided the original source is credited.
spellingShingle Original Article
Enlund, Mats
Berglund, Anders
Andreasson, Kalle
Cicek, Catharina
Enlund, Anna
Bergkvist, Leif
The choice of anaesthetic—sevoflurane or propofol—and outcome from cancer surgery: A retrospective analysis
title The choice of anaesthetic—sevoflurane or propofol—and outcome from cancer surgery: A retrospective analysis
title_full The choice of anaesthetic—sevoflurane or propofol—and outcome from cancer surgery: A retrospective analysis
title_fullStr The choice of anaesthetic—sevoflurane or propofol—and outcome from cancer surgery: A retrospective analysis
title_full_unstemmed The choice of anaesthetic—sevoflurane or propofol—and outcome from cancer surgery: A retrospective analysis
title_short The choice of anaesthetic—sevoflurane or propofol—and outcome from cancer surgery: A retrospective analysis
title_sort choice of anaesthetic—sevoflurane or propofol—and outcome from cancer surgery: a retrospective analysis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4116765/
https://www.ncbi.nlm.nih.gov/pubmed/24857018
http://dx.doi.org/10.3109/03009734.2014.922649
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