• Acta Anaesthesiol Scand · Sep 2020

    Multicenter Study

    Survival after primary breast cancer surgery following propofol or sevoflurane general anesthesia - aretrospective, multicenter, database analysis of 6,305 Swedish patients.

    • Mats Enlund, Anders Berglund, Rebecca Ahlstrand, Jakob Walldén, Johan Lundberg, Fredrik Wärnberg, Andreas Ekman, Nina Sjöblom Widfeldt, Anna Enlund, and Leif Bergkvist.
    • Center for Clinical Research, Västmanland Hospital, Uppsala University, Västerås, Sweden.
    • Acta Anaesthesiol Scand. 2020 Sep 1; 64 (8): 1048-1054.

    BackgroundRetrospective studies indicate that the choice of anesthetic can affect long-term cancer survival. Propofol seems to have an advantage over sevoflurane. However, this is questioned for breast cancer. We gathered a large cohort of breast cancer surgery patients from seven Swedish hospitals and hypothesized that general anesthesia with propofol would be superior to sevoflurane anesthesia regarding long-term breast cancer survival.MethodsWe identified all patients who were anaesthetized for breast cancer surgery between 2006 and 2012. The patients were matched to the Swedish Breast Cancer Quality Register, to retrieve tumor characteristics, prognostic factors, and adjuvant treatment as well as date of death. Overall survival between patients undergoing sevoflurane and propofol anesthesia was analyzed with different statistical approaches: (a) multiple Cox regression models adjusted for demographic, oncological, and multiple control variables, (b) propensity score matching on the same variables, but also including the participating centers as a cofactor in a separate analysis.ResultsThe database analysis identified 6305 patients. The 5-year survival rates were 91.0% and 81.8% for the propofol and sevoflurane group, respectively, in the final model (P = .126). Depending on the statistical adjustment method used, different results were obtained, from a non-significant to a "proposed" and even a "determined" difference in survival that favored propofol, with a maximum of 9.2 percentage points higher survival rate at 5 years (hazard ratio 1.46, 95% CI 1.10-1.95).ConclusionsIt seems that propofol may have a survival advantage compared with sevoflurane among breast cancer patients, but the inherent weaknesses of retrospective analyses were made apparent.© 2020 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

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