Abstract
BackgroundWhether anesthesia type is associated with the surgical outcome of Hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) remains to be determined. This study aims to investigate the impact of volatile inhalational anesthesia (INHA) versus total IV anesthesia (TIVA) on the survival outcomes in HCC patients with PVTT.MethodsA cohort of in-patients whom were diagnosed of HCC with PVTT in Eastern Hepatobiliary Surgery Hospital, Shanghai, China, from January 1, 2008 to December 24, 2012 were identified. Surgical patients receiving the INHA and TIVA were screened out. The overall survival (OS), recurrence-free survival (RFS) and several postoperative adverse events were compared according to anesthesia types.ResultsA total of 1513 patients were included in this study. After exclusions are applied, 263 patients remain in the INHA group and 208 in the TIVA group. Patients receiving INHA have a lower 5-year overall survival rate than that of patients receiving TIVA [12.6% (95% CI, 9.0 to 17.3) vs. 17.7% (95% CI, 11.3 to 20.8), P = 0.024]. Results of multivariable Cox-regression analysis also identify that INHA anesthesia is significantly associated with mortality and cancer recurrence after surgery compare to TIVA, with HR (95%CI) of 1.303 (1.065, 1.595) and 1.265 (1.040, 1.539), respectively. Subgroup analysis suggested that in more severe cancer patients, the worse outcome related to INHA might be more significant.ConclusionThis retrospective analysis identifies that TIVA is associated with better outcomes compared with INHA. Future prospective studies clinical and translational studies are required to verify this difference and investigate underlying pathophysiology.
Highlights
Whether anesthesia type is associated with the surgical outcome of Hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) remains to be determined
More studies reported similar results in different cancers [2]. Besides from these clinical evidences, animal researches reported that administration of volatile inhalational agents was associated with upregulation of tumorigenic growth factors including hypoxia-inducible factors (HIFs) and insulin-like growth factor (IGF) [3, 4], which are highly associated with progression angiogenesis and cell proliferation in tumor
We hypothesize that inhalational anesthesia (INHA) might be associated with lower 5-year overall survival (OS) compared with total IV anesthesia (TIVA) in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT), an end-stage liver cancer with a high recurrence rate and reduced median survival time (MST) [6,7,8,9], in considering that in these end stage cancer patients, even subtle differences in medication might lead to significant effects on long-term outcome
Summary
Whether anesthesia type is associated with the surgical outcome of Hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) remains to be determined. This study aims to investigate the impact of volatile inhalational anesthesia (INHA) versus total IV anesthesia (TIVA) on the survival outcomes in HCC patients with PVTT. We hypothesize that INHA might be associated with lower 5-year overall survival (OS) compared with TIVA in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT), an end-stage liver cancer with a high recurrence rate and reduced median survival time (MST) [6,7,8,9], in considering that in these end stage cancer patients, even subtle differences in medication might lead to significant effects on long-term outcome
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