• Anesthesiology · Jan 2019

    Comparative Study

    Total Intravenous Anesthesia versus Inhalation Anesthesia for Breast Cancer Surgery: A Retrospective Cohort Study.

    Cutting to the chase...

    This large, retrospective study with propensity-matched controls found NO difference in breast cancer survival between inhalataional and intravenous anesthetic techniques.

    Why is this still important?

    Following Exadaktylos' eye-popping 2006 retrospective, along with a few in vitro studies, anesthetists have been a little anxious that anesthetic technique choice could potentially have a such significant effect on cancer recurrence. To date, other trials have not replicated Exadaktylos' original results.

    What was studied this time?

    Yoo et al performed a retrospective study of 5,331 breast cancer patients over a 8 year period, looking at the relationship between anesthetic technique and both 5-year recurrence-free and overall survival.

    There was no difference for either survival metric between inhalational or intravenous anesthesia.

    So does this settle it?

    Not yet. Although large and high quality, this is still a retrospective study with all the compromises that this brings.

    Be smart

    While we await results from prospective, randomized trials, we should not be distracted by the magical promise of one technique over another, and instead address the very real impact that anesthesia can have on patient Return to Intended Oncological Therapy (RIOT).

    summary
    • Seokha Yoo, Han-Byoel Lee, Wonshik Han, Dong-Young Noh, Sun-Kyung Park, Won Ho Kim, and Jin-Tae Kim.
    • From the Departments of Anesthesiology and Pain Medicine (S.Y., S.-K.P., W.H.K., J.-T.K.) Surgery (H.-B.L., W.H., D.-Y.N.), Seoul National University Hospital the Cancer Research Institute (H.-B.L., W.H., D.-Y.N.), Seoul National University, Seoul, Korea.
    • Anesthesiology. 2019 Jan 1; 130 (1): 31-40.

    BackgroundThe association between type of anesthesia used and recurrence of cancer remains controversial. This retrospective cohort study compared the influence of total IV anesthesia and inhalation anesthesia on the primary outcome of recurrence-free survival after breast cancer surgery.MethodsThe authors reviewed the electronic medical records of patients who had breast cancer surgery at a tertiary care teaching hospital between January 2005 and December 2013. The patients were grouped according to whether IV or inhalation anesthesia was used for surgery. Propensity score matching was used to account for differences in baseline characteristics. Kaplan-Meier survival curves were constructed to evaluate the influence of type of anesthesia on recurrence-free survival and overall survival. The risks of cancer recurrence and all-cause mortality were compared between each type of anesthesia.ResultsOf 7,678 patients who had breast cancer surgery during the study period, data for 5,331 patients were available for analysis (IV group, n = 3,085; inhalation group, n = 2,246). After propensity score matching, 1,766 patients remained in each group. Kaplan-Meier survival curves showed that there was no significant difference in recurrence-free survival or overall survival between the two groups, with 5-yr recurrence-free survival rates of 93.2% (95% CI, 91.9 to 94.5) in the IV group and 93.8% (95% CI, 92.6 to 95.1) in the inhalation group. Inhalation anesthesia had no significant impact on recurrence-free survival (hazard ratio, 0.96; 95% CI, 0.69 to 1.32; P = 0.782) or overall survival (hazard ratio, 0.96; 95% CI, 0.69 to 1.33, P = 0.805) when compared with total IV anesthesia.ConclusionsThe authors found no association between type of anesthesia used and the long-term prognosis of breast cancer. The results of this retrospective cohort study do not suggest specific selection of IV or inhalation anesthesia for breast cancer surgery.

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    This article appears in the collection: Anesthesia technique and cancer recurrence.

    Notes

    summary
    1

    Cutting to the chase...

    This large, retrospective study with propensity-matched controls found NO difference in breast cancer survival between inhalataional and intravenous anesthetic techniques.

    Why is this still important?

    Following Exadaktylos' eye-popping 2006 retrospective, along with a few in vitro studies, anesthetists have been a little anxious that anesthetic technique choice could potentially have a such significant effect on cancer recurrence. To date, other trials have not replicated Exadaktylos' original results.

    What was studied this time?

    Yoo et al performed a retrospective study of 5,331 breast cancer patients over a 8 year period, looking at the relationship between anesthetic technique and both 5-year recurrence-free and overall survival.

    There was no difference for either survival metric between inhalational or intravenous anesthesia.

    So does this settle it?

    Not yet. Although large and high quality, this is still a retrospective study with all the compromises that this brings.

    Be smart

    While we await results from prospective, randomized trials, we should not be distracted by the magical promise of one technique over another, and instead address the very real impact that anesthesia can have on patient Return to Intended Oncological Therapy (RIOT).

    Daniel Jolley  Daniel Jolley
     
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