丙泊酚静脉麻醉的结肠癌手术患者术后生存率高于地氟醚麻醉者
本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见
Propofol-based Total Intravenous Anesthesia Is Associated with Better Survival Than Desflurane Anesthesia in Colon Cancer Surgery
背景与目的
研究表明麻醉药物对癌细胞的生长的影响不一，本研究旨在探讨择期结肠癌手术患者麻醉药物与术后生存率的关系。
方 法
本试验为回顾性分析，纳入 2005年1月-2014年12行择期结肠癌开放手术的患者，根据麻醉药物的不同分为两组：丙泊酚组与地氟烷组。排除标准：丙泊酚联合吸入或硬膜外麻醉、数据不完整、年龄小于20岁者。以手术日期为起点绘制生存曲线，根据倾向评分匹配分组后，应用单变量和多变量Cox回归模型比较两组死亡率。
结 果
地氟醚麻醉患者706例（307例死亡，43.5%），丙泊酚麻醉患者657例（88例死亡，13.4%）；倾向评分匹配后，每组有579名患者（地氟醚组189人死亡，32.6%；丙泊酚组87人死亡，15%） ；地氟烷组术后肿瘤复发率（9.1%，5.8%; P = 0.021）、转移率（42.5%，16.7%，P < 0.001）、死亡率（43.5%，13.4%，P < 0.001）均高于丙泊酚组；丙泊酚组患者生存率(86.6%，56.5%)、无残疾生存率（99.8%，96.7%)均高于地氟烷组。
结 论
丙泊酚静脉麻醉的结肠癌手术患者的术后生存率较高，其与肿瘤TNM分期无明显关系。
原始文献摘要
Wu ZF, Lee MS, Wong CS, et al. Propofol-based Total Intravenous Anesthesia Is Associated with Better Survival Than Desflurane Anesthesia in Colon Cancer Surgery. Anesthesiology. 2018 Nov;129(5):932-941. doi: 10.1097/ALN.0000000000002357.
Background: Previous research has shown different effects of anesthetics on cancer cell growth. Here, the authors investigated the association between type of anesthetic and patient survival after elective colon cancer surgery.
Methods: A retrospective cohort study included patients who received elective colon cancer surgery between January 2005 and December 2014. Patients were grouped according to anesthesia received: propofol or desflurane. After exclusion of those who received combined propofol anesthesia with inhalation anesthesia or epidural anesthesia, survival curves were constructed from the date of surgery to death. After propensity matching, univariable and multivariable Cox regression models were used to compare hazard ratios for death. Subgroup analyses were performed for tumor–node–metastasis staging and postoperative metastasis.
Results: A total of 706 patients (307 deaths, 43.5%) with desflurane anesthesia and 657 (88 deaths, 13.4%) with propofol anesthesia were eligible for analysis. After propensity matching, 579 patients remained in each group (189 deaths, 32.6%, in the desflurane group vs. 87, 15.0%, in the propofol group). In the matched analyses, the propofol-treated group had a better survival, irrespective of lower tumor–node–metastasis stage (hazard ratio, 0.22; 95% CI, 0.11 to 0.42; P < 0.001) or higher tumor–node–metastasis stage (hazard ratio, 0.42; 95% CI, 0.32 to 0.55; P < 0.001) and presence of metastases (hazard ratio,0.67; 95% CI, 0.51 to 0.86; P = 0.002) or absence of metastases (hazard ratio, 0.08; 95% CI, 0.01 to 0.62; P = 0.016). Simple propensity score adjustment produced similar findings.
Conclusions: Propofol anesthesia for colon cancer surgery is associated with better survival irrespective of tumor– node–metastasis stage
麻醉学文献进展分享
贵州医科大学高鸿教授课题组