title: Effects of propofol-based total intravenous anesthesia on recurrence and overall survival in patients after modified radical mastectomy: a retrospective study.
abstract: BACKGROUND
  The optimal combination of anesthetic agent and technique may have an influence on long-term outcomes in cancer surgery. In vitro and in vivo studies suggest that propofol independently reduces migration of cancer cells and metastasis. Thus, the authors retrospectively examined the link between propofol-based total intravenous anesthesia (TIVA) and recurrence or overall survival in patients undergoing modified radical mastectomy (MRM).
  
  
  METHODS
  A retrospective analysis of the electronic database of all patients undergoing MRM for breast cancer between January 2007 and December 2008 was undertaken. Patients received either propofol-based TIVA (propofol group) or sevoflurane-based anesthesia (sevoflurane group). We analyzed prognostic factors of breast cancer and perioperative factors and compared recurrence-free survival and overall survival between propofol and sevoflurane groups.
  
  
  RESULTS
  A total of 363 MRMs were carried out during the period of the trial; 325 cases were suitable for analysis (173 cases of propofol group, and 152 cases of sevoflurane group). There were insignificant differences between the groups in age, weight, height, histopathologic results, surgical time, or postoperative treatment (chemotherapy, hormonal therapy, and radiotherapy). The use of opioids during the perioperative period was greater in propofol group than in sevoflurane group. Overall survival was no difference between the two groups. Propofol group showed a lower rate of cancer recurrence (P = 0.037), with an estimated hazard ratio of 0.550 (95% CI 0.311-0.973).
  
  
  CONCLUSIONS
  This retrospective study provides the possibility that propofol-based TIVA for breast cancer surgery can reduce the risk of recurrence during the initial 5 years after MRM.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Center for Breast Cancer, Korea Cancer Center Hospital, Seoul, Korea.
authors.forename: Ji Heui
authors.identifier: 0000-0003-3378-588X
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Center for Breast Cancer, Korea Cancer Center Hospital, Seoul, Korea.
authors.forename: Seok Hee
authors.initials: SH
authors.lastname: Kang
authors.affiliation: Department of Anesthesiology and Pain Medicine, Center for Breast Cancer, Korea Cancer Center Hospital, Seoul, Korea.
authors.forename: Yunkwang
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Department of General Surgery, Center for Breast Cancer, Korea Cancer Center Hospital, Seoul, Korea.
authors.forename: Hyun Ah
authors.initials: HA
authors.lastname: Kim
authors.affiliation: Department of Hemato-oncology, Veterans Health Service Medical Center, Seoul, Korea.
authors.forename: Bong Seog
authors.initials: BS
authors.lastname: Kim
keywords: Breast neoplasms; Propofol; Recurrence; Sevoflurane