Abstract
BackgroundThe relationship between the type of anesthesia and the survival outcomes of gastric cancer patients is uncertain. This study compared the overall outcome of gastric cancer patients after surgery with total intravenous anesthesia (TIVA) or inhalation anesthesia (IHA).MethodsClinicopathological variables of gastric cancer patients were retrieved from the database of the Surgical Gastric Cancer Patient Registry in West China Hospital, Sichuan University. Patients were grouped according to whether they received TIVA or IHA during the operation. Propensity score (PS) matching was used to balance the baseline variables, and survival outcomes were compared between these two groups. In addition, studies comparing survival outcomes between TIVA and IHA used for gastric cancer surgery and published before April 20th, 2020, were identified, and their data were pooled.ResultsA total of 2827 patients who underwent surgical treatment from Jan 2009 to Dec 2016 were included. There were 323 patients in the TIVA group and 645 patients in the IHA group, with 1:2 PS matching. There was no significant difference in overall survival outcomes between the TIVA and IHA groups before matching the cohort (p = 0.566) or after matching the cohort (p = 0.679) by log-rank tests. In the Cox hazard regression model, there was no significant difference between the TIVA and IHA groups before (HR: 1.054, 95% CI: 0.881–1.262, p = 0.566) or after (HR: 0.957, 95% CI: 0.779–1.177, p = 0.679) PS matching. The meta-analysis of survival outcomes between the TIVA and IHA groups found critical statistical value in the before PS matching cohort (HR 0.74, 95% CI: 0.57–0.96 p < 0.01) and after PS matching cohort (HR: 0.65, 95% CI: 0.46–0.94, p < 0.01).ConclusionsCombined with the results of previous studies, total intravenous anesthesia has been shown to be superior to inhalation anesthesia in terms of overall survival for gastric cancer patients undergoing surgical treatment. The selection of intravenous or inhalation anesthesia for gastric cancer surgery should take into account the long-term prognosis of the patient.
Highlights
Gastric cancer is one of the most common malignant diseases of the digestive system, especially in East Asian countries [1, 2]
The selection of intravenous or inhalation anesthesia for gastric cancer surgery should take into account the long-term prognosis of the patient
According to the inclusion criteria and exclusion criteria, 2827 patients were included in the final analysis, 344 patients with total intravenous anesthesia were in the TIVA group, and 2483 patients with inhalation anesthesia were in the IHA group
Summary
Gastric cancer is one of the most common malignant diseases of the digestive system, especially in East Asian countries [1, 2]. Radical surgical treatment with perioperative chemotherapy is the major treatment choice according to the latest treatment guidelines [3, 4] Several clinicopathological variables, such as macroscopic type, Lauren classification, differentiation degree of the tumor, tumor stage, resection degree, resection patterns, and lymphadenectomy degree, are independent prognostic factors of gastric cancer patients [5, 6]. Immunosuppression attributable to anesthetics may accelerate the growth and metastases of cancer cells and result in poor survival of patients with malignant diseases [7]. Anesthetics can result in immunological suppression by influencing the function of natural killer cells, as shown in a clinical study of breast cancer patients [9]. This study compared the overall outcome of gastric cancer patients after surgery with total intravenous anesthesia (TIVA) or inhalation anesthesia (IHA)
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