Retrospective analysis of 1-year mortality after gastric cancer surgery: Total intravenous anesthesia versus volatile anesthesia

Abstract

Background It remains controversial whether propofol-based total intravenous anesthesia (TIVA) or inhalation anesthesia is associated with better outcomes after cancer surgery. We investigated whether there is a difference in the 1-year overall or cancer-related mortality between propofol-based TIVA and inhalation anesthesia in patients who underwent gastric cancer surgery. Methods This retrospective cohort study was based on medical records of ll patients aged >= 18 years who underwent elective gastric cancer surgery with curative intent between January 2005 and December 2015 at a single tertiary academic hospital. Propensity score (PS) matching and Cox proportional hazard models were used for analyses. Results After PS matching, 1538 patients (769 patients in each group) were included in the final analysis. The 1-year overall mortality risk was not significantly different between the TIVA and inhalation groups in either the PS-matched analysis [hazard ratio (HR): 0.92, 95% confidence interval (CI): 0.52-1.64; P = 0.774] or entire cohorts (HR: 0.82 95% CI: 0.52-1.33; P = 0.417) after multivariable adjustment. The 1-year cancer-related mortality risk was similar between the groups in both the PS-matched cohort (HR: 0.91, 95% CI: 0.50-1.67; P = 0.764) and the entire cohort after multivariable adjustment (HR: 0.82, 95% CI: 0.50-1.33; P = 0.406). Conclusions We show that propofol-based TIVA was not significantly associated with a decrease in the 1-year overall or cancer-related mortality after gastric cancer surgery, as compared with inhalation anesthesia. Further studies are required to ascertain the optimal anesthetic choice for gastric cancer surgery.