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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

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机构: [1]Department of Anesthesiology, Peking University First Hospital, Beijing, China, [2]Clinical Research Institute, Shenzhen PekingUniversityeThe Hong Kong University of Science & Technology Medical Center, Shenzhen, China, [3]Department ofAnesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China, [4]Department of Anesthesiology,Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China, [5]Department ofAnesthesiology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, Shaanxi,China, [6]Department of Anesthesiology, Affiliated Hospital of Qinghai University, Xining, Qinghai, China, [7]Department ofAnesthesiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China, [8]Department ofAnesthesiology, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia Hui Autonomous Region,China, [9]Department of Anesthesiology, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, China, [10]Department ofAnesthesiology, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi, China, [11]Department of Anesthesiology, Pain andPerioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China, [12]Department ofAnesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China, [13]Department of Anesthesiology andCritical Care Medicine, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China, [14]Department of Anesthesiology,Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen,Guangdong, China, [15]Department of Anesthesiology, Zhongda Hospital, Medical School of Southeast University, Nanjing,Jiangsu, China, [16]Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu,China, [17]Department of Biostatistics, Peking University First Hospital, Beijing, China, [18]Peking University Clinical ResearchInstitute, Peking University Health Science Center, Beijing, China, [19]Outcomes Research Consortium, Cleveland Clinic,Cleveland, OH, USA, [20]Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Facultyof Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK, [21]Department of Outcomes Research,Anesthesiology Institute, OH, USA [22]National Clinical Research Center for Child Health, Hangzhou, China
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关键词: aged cancer surgery inhalation anaesthesia intravenous anaesthesia morbidity propofol sevoflurane survival

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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.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 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.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): 0.83-1.26; 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.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.ChiCTR-IPR-15006209; NCT02660411.Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.

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大类 | 1 区 医学
小类 | 1 区 麻醉学
最新[2025]版:
大类 | 1 区 医学
小类 | 1 区 麻醉学
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出版当年[2023]版:
Q1 ANESTHESIOLOGY
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Q1 ANESTHESIOLOGY

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