دورية أكاديمية
Long-term survival in older patients given propofol or sevoflurane anaesthesia for major cancer surgery: follow-up of a multicentre randomised trial.
| العنوان: | Long-term survival in older patients given propofol or sevoflurane anaesthesia for major cancer surgery: follow-up of a multicentre randomised trial. |
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| المؤلفون: | Cao SJ; Department of Anesthesiology, Peking University First Hospital, Beijing, China., Zhang Y; Department of Anesthesiology, Peking University First Hospital, Beijing, China; Clinical Research Institute, Shenzhen Peking University-The Hong Kong University of Science & Technology Medical Center, Shenzhen, China., Zhang YX; Department of Anesthesiology, Peking University First Hospital, Beijing, China., Zhao W; Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China., Pan LH; Department of Anesthesiology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China., Sun XD; Department of Anesthesiology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, Shaanxi, China., Jia Z; Department of Anesthesiology, Affiliated Hospital of Qinghai University, Xining, Qinghai, China., Ouyang W; Department of Anesthesiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China., Ye QS; Department of Anesthesiology, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia Hui Autonomous Region, China., Zhang FX; Department of Anesthesiology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China., Guo YQ; Department of Anesthesiology, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China., Ai YQ; Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China., Zhao BJ; Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China., Yu JB; Department of Anesthesiology and Critical Care Medicine, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China., Liu ZH; Department of Anesthesiology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, Guangdong, China., Yin N; Department of Anesthesiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, China; Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China., Li XY; Department of Biostatistics, Peking University First Hospital, Beijing, China., Ma JH; Department of Anesthesiology, Peking University First Hospital, Beijing, China., Li HJ; Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, China., Wang MR; Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, China., Sessler DI; Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA; Department of Outcomes Research, Anesthesiology Institute, OH, USA., Ma D; Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK; National Clinical Research Center for Child Health, Hangzhou, China., Wang DX; Department of Anesthesiology, Peking University First Hospital, Beijing, China; Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA. Electronic address: dxwang65@bjmu.edu.cn. |
| مؤلفون مشاركون: | First Study of Perioperative Organ Protection (SPOP1) investigators |
| المصدر: | British journal of anaesthesia [Br J Anaesth] 2023 Aug; Vol. 131 (2), pp. 266-275. Date of Electronic Publication: 2023 Jun 04. |
| نوع المنشور: | Randomized Controlled Trial; Multicenter Study; Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: England NLM ID: 0372541 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1471-6771 (Electronic) Linking ISSN: 00070912 NLM ISO Abbreviation: Br J Anaesth Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2018- : [London] : Elsevier Original Publication: London, Eng. [etc.] |
| مواضيع طبية MeSH: | Propofol*/adverse effects , Sevoflurane*/adverse effects , Neoplasms*/surgery, Humans ; Male ; Female ; Aged ; Follow-Up Studies ; Anesthetics, Intravenous ; Anesthesia, Inhalation ; Cancer Survivors |
| مستخلص: | Background: Experimental evidence indicates that i.v. anaesthesia might reduce cancer recurrence compared with volatile anaesthesia, but clinical information is observational only. We therefore tested the primary hypothesis that propofol-based anaesthesia improves survival over 3 or more years after potentially curative major cancer surgery. Methods: This was a long-term follow-up of a multicentre randomised trial in 14 tertiary hospitals in China. We enrolled 1228 patients aged 65-90 yr who were scheduled for major cancer surgery. They were randomised to either propofol-based i.v. anaesthesia or to sevoflurane-based inhalational anaesthesia. The primary endpoint was overall survival after surgery. Secondary endpoints included recurrence-free and event-free survival. Results: Amongst subjects randomised, 1195 (mean age 72 yr; 773 [65%] male) were included in the modified intention-to-treat analysis. At the end of follow-up (median 43 months), there were 188 deaths amongst 598 patients (31%) assigned to propofol-based anaesthesia compared with 175 deaths amongst 597 patients (29%) assigned to sevoflurane-based anaesthesia; adjusted hazard ratio 1.02; 95% confidence interval (CI): 0.83-1.26; P=0.834. Recurrence-free survival was 223/598 (37%) in patients given propofol anaesthesia vs 206/597 (35%) given sevoflurane anaesthesia; adjusted hazard ratio 1.07; 95% CI: 0.89-1.30; P=0.465. Event-free survival was 294/598 (49%) in patients given propofol anaesthesia vs 274/597 (46%) given sevoflurane anaesthesia; adjusted hazard ratio 1.09; 95% CI 0.93 to 1.29; P=0.298. Conclusions: Long-term survival after major cancer surgery was similar with i.v. and volatile anaesthesia. Propofol-based iv. anaesthesia should not be used for cancer surgery with the expectation that it will improve overall or cancer-specific survival. Clinical Trial Registrations: ChiCTR-IPR-15006209; NCT02660411. (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.) |
| التعليقات: | Comment in: Br J Anaesth. 2023 Aug;131(2):193-196. (PMID: 36863979) Comment in: Br J Anaesth. 2023 Aug;131(2):253-265. (PMID: 37474241) Comment in: Br J Anaesth. 2023 Oct;131(4):629-631. (PMID: 37544837) |
| فهرسة مساهمة: | Keywords: aged; cancer surgery; inhalation anaesthesia; intravenous anaesthesia; morbidity; propofol; sevoflurane; survival |
| سلسلة جزيئية: | ClinicalTrials.gov NCT02660411 |
| المشرفين على المادة: | YI7VU623SF (Propofol) 38LVP0K73A (Sevoflurane) 0 (Anesthetics, Intravenous) |
| تواريخ الأحداث: | Date Created: 20230720 Date Completed: 20230728 Latest Revision: 20231003 |
| رمز التحديث: | 20231215 |
| DOI: | 10.1016/j.bja.2023.01.023 |
| PMID: | 37474242 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1471-6771 |
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| DOI: | 10.1016/j.bja.2023.01.023 |