Abstract
Anaesthetics used during cancer surgery may influence tumour cells and immunological response. The aim of this study was to evaluate a potential influence of the anaesthetic method (inhaled anaesthetics versus total-intravenous anaesthesia using propofol) on recurrence-free and overall survival in glioblastoma patients. We retrospectively identified patients undergoing resection of contrast enhancing glioblastoma under general anaesthesia followed by standard adjuvant treatment between January 2010 and February 2017 at two University Hospitals. Matched pairs of patients receiving either balanced with volatile anaesthetics or total intravenous anaesthesia were generated according to the known prognostic factors (extent of resection, methyl-guanine-methyl-transferase (MGMT) promoter methylation, age, Karnofsky performance score). Groups were compared using chi-square and Whitney-Man-U test. Time to recurrence was calculated using Kaplan Meier estimates. Log Rank test was used to assess the influence of the anaesthetic method. One hundred and fifty-eight (79:79) patients were included. Groups showed no significant difference in recurrence-free (volatiles: 8.0 (95% CI 6.5–9.8) vs. propofol: 8.4 (95% CI 7.9–10.1) months; p = 0.54) or overall survival (propofol: 17.4 (95% CI 14.0–20.7) vs. volatiles: 16.9 (95% CI 13.9–20.1) months; p = 0.85). In contrast to potential beneficial effects in some other solid tumours, the choice of anaesthetic method had no impact on survival in patients with glioblastoma in a well-defined cohort.
Highlights
Anaesthetics used during cancer surgery may influence tumour cells and immunological response
While numerous studies have focused on surgical techniques and the extent of glioblastoma resection, the influence of the medication used for anaesthesia during surgery on patient outcome remains largely unclear, the substances used are capable of passing the blood-brain barrier and have pleiotropic effects
The choice of the anaesthetic method did not influence time to recurrence or overall survival. These findings suggest that either anaesthetics have no impact on glioblastoma or the biological behaviour of these tumours is too aggressive to respond to perioperative influences
Summary
Anaesthetics used during cancer surgery may influence tumour cells and immunological response. The aim of this study was to evaluate a potential influence of the anaesthetic method (inhaled anaesthetics versus total-intravenous anaesthesia using propofol) on recurrence-free and overall survival in glioblastoma patients. In contrast to potential beneficial effects in some other solid tumours, the choice of anaesthetic method had no impact on survival in patients with glioblastoma in a well-defined cohort. While numerous studies have focused on surgical techniques and the extent of glioblastoma resection, the influence of the medication used for anaesthesia during surgery on patient outcome remains largely unclear, the substances used (e.g. propofol, fluranes, opioids, benzodiazepines) are capable of passing the blood-brain barrier and have pleiotropic effects. Since an effect on glioma cells and the patientsfurther course may be supposed, and if present, would be highly relevant in a rapidly progressive and fatal disease, we investigated the influence of the chosen anaesthetics on the prognosis of patients with GBM
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