Key result
Propofol-based total intravenous anesthesia was associated with a 9% lower 90-day mortality (HR 0.91) compared to inhalation anesthesia in patients undergoing major cancer surgery.
Why the study?
The optimal anesthetic technique for cancer surgery remains controversial, leading researchers to examine survival outcomes associated with propofol-based total intravenous anesthesia versus inhalation anesthesia.
Does propofol-based TIVA improve survival outcomes compared to inhalation anesthesia in adult patients undergoing major cancer surgery?
Cohort (n=115,370)
Does propofol-based TIVA improve survival outcomes compared to inhalation anesthesia in adult patients undergoing major cancer surgery?
Hazard Ratio: 0.91 (95% CI 0.85–0.98)
p-value: p=0.018
Propofol-based total intravenous anesthesia is associated with significantly lower 90-day and one-year mortality compared to inhalation anesthesia in patients undergoing major cancer surgery.
TIVA associated with lower mortality after cancer surgery; leaves open causal benefit and requires RCT confirmation before practice change.
BACKGROUND: The optimal anesthetic technique for cancer surgery remains a controversial issue. This study aimed to examine whether propofol-based total intravenous anesthesia (TIVA) was associated with survival outcomes after major cancer surgery in South Korea and compare its effectiveness with that of inhalation anesthesia. METHODS: This nationwide population-based cohort study included adult patients who were admitted to the hospital and underwent major cancer surgery between January 1, 2016, and December 31, 2020. The major cancers included lung, gastric, colorectal, esophageal, small bowel, liver, pancreatic, and bile duct or gallbladder cancers. RESULTS: A total of 253,003 patients who underwent major cancer surgery were included in the analysis. After propensity score (PS) matching, 115,370 patients (57,685 in each group) were included in the final analysis. In the PS-matched cohort, the TIVA group showed 9% (hazard ratio [HR]: 0.91, 95% CI [0.85, 0.98], P = 0.018) and 7% (HR: 0.93, 95% CI [0.89, 0.96], P < 0.001) lower 90-day and one-year mortality rates, respectively, than the inhalation group. In subgroup analyses, the TIVA group showed lower 90-day mortality than the inhalation group in the gastric (HR: 0.86, 95% CI [0.72, 0.97], P = 0.033), colorectal (HR: 0.64, 95% CI [0.56, 0.73], P < 0.001), and pancreatic (HR: 0.76, 95% CI [0.57, 0.94], P = 0.038) cancer surgery groups. CONCLUSIONS: Propofol-based TIVA is associated with better survival outcomes after major cancer surgeries. Moreover, propofol-based TIVA was beneficial in patients who underwent gastric, colorectal, and pancreatic cancer surgeries.
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Oh et al. (2023) conducted a cohort in Major cancer surgery (n=115,370). Propofol-based total intravenous anesthesia (TIVA) vs. Inhalation anesthesia was evaluated on 90-day mortality (HR 0.91, 95% CI 0.85-0.98, p=0.018). Propofol-based total intravenous anesthesia was associated with a 9% lower 90-day mortality (HR 0.91) compared to inhalation anesthesia in patients undergoing major cancer surgery.
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