West China Hospital Research: Improve the prognosis of patients undergoing gastric cancer surgery, and anesthesiologists can also contribute!

Gastric cancer is one of the most common malignant diseases of the digestive system, especially in East Asian countries
.

According to the latest treatment guidelines, radical surgery + perioperative chemotherapy is the main treatment option

Gastric cancer is one of the most common malignant diseases of the digestive system, especially in East Asian countries

Studies have found that total intravenous anesthesia based on propofol has less immunosuppressive effects than inhalation anesthesia based on sevoflurane or desflurane
.

However, the debate about the effect of the type of anesthesia on the long-term survival of patients with malignant tumors has not been resolved

Studies have found that total intravenous anesthesia based on propofol has less immunosuppressive effects than inhalation anesthesia based on sevoflurane or desflurane

This study conducted a single-center retrospective cohort study with a large sample size, and adjusted the clinicopathological prognostic characteristics of total intravenous anesthesia (TIVA) and inhalation anesthesia (IHA) through the propensity score (PS) matching method

From January 2009 to December 2016, 3426 patients were treated in the Department of Gastrointestinal Surgery, West China Hospital of Sichuan University
.

According to the inclusion and exclusion criteria, 2827 patients were finally included.

From January 2009 to December 2016, 3426 patients were treated in the Department of Gastrointestinal Surgery, West China Hospital of Sichuan University

First evaluate the survival results of the TIVA and IHA groups, before PS matching (HR: 1.
054, 95% CI: 0.
881-1.
262, p= 0.
566) and after PS matching (HR: 0.
957, 95% CI: 0.
779-1.
177, p = 0.
679), there was no difference in survival outcomes between TIVA and IHA groups (Figure 3 and Figure 4)

First evaluate the survival results of the TIVA and IHA groups, before PS matching (HR: 1.
054, 95% CI: 0.
881-1.
262, p= 0.
566) and after PS matching (HR: 0.
957, 95% CI: 0.
779-1.
177, p = 0.
679), there was no difference in survival results between the TIVA and IHA groups (Figure 3 and Figure 4).
First, the survival results of the TIVA and IHA groups were evaluated, before PS matching (HR: 1.
054, 95% CI: 0.
881-1.
262, p= 0.
566) and PS matched (HR: 0.
957, 95% CI: 0.
779-1.
177, p = 0.
679), there was no difference in survival results between TIVA and IHA groups (Figure 3 and Figure 4) p p

The univariate and multivariate survival analysis of patients before and after pairing were analyzed and shown in Table 2 and Table 3
.

Age, tumor size, general type, degree of radical cure, pathological TNM staging, and postoperative adjuvant chemotherapy are independent prognostic risk factors that affect overall survival

The univariate and multivariate survival analysis of patients before and after pairing were analyzed and shown in Table 2 and Table 3

According to the final pathological stage, the patients were subgroup analyzed
.

Patients in the TIVA group and IHA group had similar survival rates in the pTNM stage (Figure 3 and Figure 4)

According to the final pathological stage, the patients were subgroup analyzed

Through literature search, three published studies were found to compare the survival outcomes of the TIVA group and the IHA group
.
At the same time, we added the survival results of this study to the meta-analysis
.
The general characteristics of the study are shown in Table 4
.
Both studies used propensity score matching methods to balance the clinicopathological characteristics between the TIVA group and the IHA group
.
Therefore, we performed a meta-analysis of the survival results before and after PS matching (Figure 5A and B)
.
Before PS pairing (HR 0.
74, 95% CI: 0.
57–0.
96, p < 0.
01) or after (HR 0.
65, 95% CI: 0.
46–0.
94, p < 0.
01) , there was a statistical difference between the TIVA group and the IHA group Meaning
.
(HR 0.
74, 95% CI: 0.
57--0.
96, p < 0.
01) or (HR 0.
65, 95% CI: 0.
46--0.
94, p < 0.
01)

In summary, combined with the results of previous studies , total intravenous anesthesia is better than inhalation anesthesia in terms of the overall survival rate of patients undergoing gastric cancer surgery
.
The choice of intravenous anesthesia and inhalation anesthesia in gastric cancer surgery should comprehensively consider the impact on the long-term prognosis of patients
.

In summary, combined with the results of previous studies , total intravenous anesthesia is better than inhalation anesthesia in terms of the overall survival rate of patients undergoing gastric cancer surgery
.
In terms of overall survival rate of patients undergoing surgery for gastric cancer, total intravenous anesthesia is better than inhalation anesthesia
.
The choice of intravenous anesthesia and inhalation anesthesia in gastric cancer surgery should comprehensively consider the impact on the long-term prognosis of patients
.
The choice of intravenous anesthesia and inhalation anesthesia in gastric cancer surgery should comprehensively consider the impact on the long-term prognosis of patients
.

Original source:

Wu et al.
The long-term survival outcomes of gastric cancer patients with total intravenous anesthesia or inhalation anesthesia: a single-center retrospective cohort study.
BMC Cancer (2021) 21:1193
https://doi.
org/10.
1186/s12885- 021-08946-7

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