吸入麻醉与全凭静脉麻醉对消化道肿瘤手术患者预后的影响

背景：以往的实验及临床研究表明，不同麻醉剂对癌症患者手术预后的影响不同，但这些研究结果并不一致。本研究对接受吸入麻醉或全凭静脉麻醉的消化道肿瘤手术患者的总体生存率和无癌复发生存率进行了比较。

方法：作者使用日本诊断程序组合数据库，选择了从2010年7月至2018年3月期间接受择期食管切除术、胃切除术、肝切除术、胆囊切除术、胰腺切除术、结肠切除术及直肠癌手术的患者。患者被分为吸入麻醉组(地氟醚、七氟醚或异氟醚加/不加氧化二氮)和丙泊酚全凭静脉麻醉组，并假设全凭静脉麻醉比吸入麻醉具有更高的总体生存率和无癌复发生存率。对每种手术类型进行亚组分析。

结果：共纳入196303名符合条件患者(吸入麻醉组166,966名、丙泊酚全凭静脉麻醉组29,337)；吸入麻醉组和全凭静脉麻醉组死亡人数(比例)分别为17319例(10.4%)和3339例(11.4%)。两组总生存率(风险比 1.02；95%CI 0.98~1.07；P=0.28)或无癌复发生存率(风险比 0.99；95%CI 0.96~1.03；P=0.59)无显著性差异，而工具变量分析显示，两组无复发生存率略有差异(风险比 0.92；95%CI 0.87~0.98；P=0.01)。亚组分析显示，在任何类型的手术中，各组之间的总体或无癌复发生存率没有显著差异。

结论：在接受消化道手术的患者中，吸入麻醉和全凭静脉麻醉的总体生存率和无癌复发生存率相似，此类患者麻醉方式的选择应基于其他因素。

原始文献来源： Makito K,  Matsui H,  Fushimi K, et al.Volatile versus Total Intravenous Anesthesia for Cancer Prognosis in Patients Having Digestive Cancer Surgery.[J].Anesthesiology 2020 Oct 01;1334(4) .

Volatile versus Total Intravenous Anesthesia for Cancer Prognosis in Patients Having Digestive Cancer Surgery

ABSTRACT

Background: Previous experimental and clinical studies have shown that anesthetic agents have varying effects on cancer prognosis; however, the results were inconsistent among these studies. The authors compared overall and recurrence-free survival in patients given volatile or intravenous anesthesia for digestive tract cancer surgery.

Methods: The authors selected patients who had elective esophagectomy, gastrectomy, hepatectomy, cholecystectomy, pancreatectomy, colectomy, and rectal cancer surgery from July 2010 to March 2018 using the Japanese Diagnosis Procedure Combination database. Patients were divided into a volatile anesthesia group (desflurane, sevoflurane, or isoflurane with/without nitrous oxide) and a propofol-based total intravenous anesthesia group. The authors hypothesized that total intravenous anesthesia is associated with greater overall and recurrence-free survival than volatile anesthesia. Subgroup analyses were performed for each type of surgery.

Results: The authors identified 196,303 eligible patients (166,966 patients in the volatile anesthesia group and 29,337 patients in the propofol-based total intravenous anesthesia group). The numbers (proportions) of death in the volatile anesthesia and total intravenous anesthesia groups were 17,319 (10.4%) and 3,339 (11.4%), respectively. There were no significant differences between the two groups in overall survival (hazard ratio, 1.02; 95% CI, 0.98 to 1.07; P = 0.28) or recurrence-free survival (hazard ratio, 0.99; 95% CI, 0.96 to 1.03; P = 0.59), whereas instrumental variable analyses showed a slight difference in recurrence-free survival (hazard ratio, 0.92; 95% CI, 0.87 to 0.98; P = 0.01). Subgroup analyses showed no significant difference in overall or recurrence-free survival between the groups in any type of surgery.

Conclusions: Overall and recurrence-free survival were similar between volatile and intravenous anesthesia in patients having digestive tract surgery. Selection of the anesthetic approach for these patients should be based on other factors.