title: The choice of anaesthetic--sevoflurane or propofol--and outcome from cancer surgery: a retrospective analysis.
abstract: BACKGROUND
  Commonly used inhalational hypnotics, such as sevoflurane, are pro-inflammatory, whereas the intravenously administered hypnotic agent propofol is anti-inflammatory and anti-oxidative. A few clinical studies have indicated similar effects in patients. We examined the possible association between patient survival after radical cancer surgery and the use of sevoflurane or propofol anaesthesia.
  
  
  METHODS
  Demographic, anaesthetic, and surgical data from 2,838 patients registered for surgery for breast, colon, or rectal cancers were included in a database. This was record-linked to regional clinical quality registers. Cumulative 1- and 5-year overall survival rates were assessed using the Kaplan-Meier method, and estimates were compared between patients given propofol (n = 903) or sevoflurane (n = 1,935). In a second step, Cox proportional hazard models were calculated to assess the risk of death adjusted for potential effect modifiers and confounders.
  
  
  RESULTS
  Differences in overall 1- and 5-year survival rates for all three sites combined were 4.7% (p = 0.004) and 5.6% (p < 0.001), respectively, in favour of propofol. The 1-year survival for patients operated for colon cancer was almost 10% higher after propofol anaesthesia. However, after adjustment for several confounders, the observed differences were not statistically significant.
  
  
  CONCLUSIONS
  Propofol anaesthesia might be better in surgery for some cancer types, but the retrospective design of this study, with uneven distributions of several confounders, distorted the picture. These uncertainties emphasize the need for a randomized controlled trial.
authors.affiliation: Centre for Clinical Research and Department of Anaesthesia and Intensive Care, Central Hospital , Västerås , Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Enlund
authors.forename: Anders
authors.initials: A
authors.lastname: Berglund
authors.forename: Kalle
authors.initials: K
authors.lastname: Andreasson
authors.forename: Catharina
authors.initials: C
authors.lastname: Cicek
authors.forename: Anna
authors.initials: A
authors.lastname: Enlund
authors.forename: Leif
authors.initials: L
authors.lastname: Bergkvist
mesh_terms: D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D006801:Humans; D008738:Methyl Ethers / Q000008:administration & dosage*; D009369:Neoplasms / Q000601:surgery*; D015742:Propofol / Q000008:administration & dosage*; D012189:Retrospective Studies; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D015742:Propofol
keywords: Anaesthetics; epidemiology; inhalational; intravenous; local; neoplasm recurrence; survival