The choice of anaesthetic—sevoflurane or propofol—and outcome from cancer surgery: A retrospective analysis

Figures & data

Figure 1. Study population.

Table I. Demographic and clinical characteristics of patients operated for colon, rectal, or breast cancer between 1997 and 2010.

	Colon cancer		Rectal cancer		Breast cancer
	Propofol	Sevoflurane	Propofol	Sevoflurane	Propofol	Sevoflurane
All patients	179	516	104	202	620	1217
Calendar period
1997–2000	1	201	0	75	4	367
2001–2004	80	200	45	73	124	696
2005–2007	50	81	28	44	222	136
2008–2010	48	34	31	10	270	18
Sex
Male	85	259	60	121	3	3
Female	94	257	44	81	617	1214
Age at diagnosis
<59 years	32	88	25	52	295	548
60–69 years	61	112	34	60	163	300
70–79 years	58	197	37	67	92	211
>80 years	28	119	8	23	70	158
Smoking history
Never	110	253	58	86	417	593
Ex-smoker	40	89	29	42	67	94
Smoker	25	57	13	29	109	189
Cardiac failure
No history	168	466	102	195	606	1164
Positive history	10	50	2	6	14	47
Cardiac ischemia
No history	149	405	95	181	590	1112
Positive history	29	111	8	20	29	102
ASA classification
1	18	52	21	32	182	384
2	114	261	61	123	355	630
3	42	175	21	45	77	178
4	4	28	1	2	4	17

Table II. Perioperative characteristics of patients operated for colon, rectal, or breast cancer between 1997 and 2010.

	Colon cancer		Rectal cancer		Breast cancer
	Propofol	Sevoflurane	Propofol	Sevoflurane	Propofol	Sevoflurane
Duration of anaesthesia
Mean (SD), minutes	253 (83)	230 (75)	366 (93)	349 (72)	119 (41)	110 (43)
Epidural anaesthesia
No	11	88	2	5	620	1176
Yes	168	406	102	188	0	0
Nitrous oxide
Yes	0	7	0	6	5	305
No	155	463	90	179	533	792
Blood loss
Mean (SD), mL	350 (349)	375 (384)	815 (755)	857 (551)	85 (134)	137 (172)
Transfusions
1	34	94	17	45	6	26
2	24	66	17	39	1	12
3	6	12	9	11	0	2
4+	1	10	7	5	1	3
Duration of surgery
Mean (SD), minutes	204 (77)	185 (71)	309 (90)	294 (69)	86 (38)	80 (40)
Type of surgery
Emergency	11	129	–	–	–	–
Elective	168	387	–	–	–	–
Re-operations
No re-operations	148	453	59	124	480	891
One or more re-operations	31	63	45	78	140	326
Type of anaesthesia (during re-operation)
Propofol	12	9	20	19	103	49
Sevoflurane	17	50	25	57	34	270
Other	2	1	0	1	1	5

Figure 2. Kaplan–Meier curve for survival after propofol- or sevoflurane-based anaesthesia for all cancer sites.

Table III. Proportions of 1- and 5-year survival for patients anaesthetized with propofol or sevoflurane and the difference between anaesthesia groups for patients diagnosed with colon, rectal, or breast cancer between 1997 and 2010.

	Propofol (95% CI)	Sevoflurane (95% CI)	Difference in survival (propofol minus sevoflurane) (95% CI)
1-year survival
All sites	0.97 (0.96–0.98)	0.93 (0.92–0.94)	0.04 (0.03–0.06)	p < 0.001
Colon cancer	0.93 (0.89–0.97)	0.84 (0.81–0.87)	0.09 (0.04–0.14)	p < 0.001
Rectal cancer	0.95 (0.91–0.99)	0.96 (0.93–0.98)	–0.01 (–0.05–0.05)	n.s.
Breast cancer	0.99 (0.98–1.00)	0.96 (0.95–0.97)	0.03 (0.01–0.04)	p < 0.001
5-year survival
All sites	0.78 (0.75–0.82)	0.73 (0.71–0.75)	0.05 (0.02–0.09)	p < 0.01
Colon cancer	0.63 (0.56–0.72)	0.53 (0.48–0.57)	0.11 (0.02–0.20)	p < 0.05
Rectal cancer	0.73 (0.64–0.83)	0.67 (0.60–0.74)	0.06 (–0.06–0.17)	n.s.
Breast cancer	0.84 (0.81–0.88)	0.82 (0.80–0.85)	0.02 (–0.02–0.06)	n.s

CI = confidence interval; n.s. = non-significant.

Table IV. Hazard ratios and the corresponding 95% confidence intervals for clinical characteristics that significantly differed in univariate analyses for patients diagnosed with colon, rectal, or breast cancer between 1997 and 2010.

	Colon cancer				Rectal cancer				Breast cancer
	Univariate		Multivariate		Univariate		Multivariate		Univariate		Multivariate
	HR	(95% CI)	HR	(95% CI)	HR	(95% CI)	HR	(95% CI)	HR	(95% CI)	HR	(95% CI)
Anaesthesia
Sevoflurane	1.00	Reference	1.00	Reference	1.00	Reference	1.00	Reference	1.00	Reference	1.00	Reference
Propofol	0.74	(0.60–0.93)	0.94 0.93	(0.71–1.25) (0.71–1.21)	0.80	(0.52–1.22)	0.83 0.87	(0.52–1.31) (0.55–1.37)	0.84	(0.65–1.08)	1.33 1.31	(0.91–1.94) (0.93–1.91)
Calendar period
1997–2000	1.00	Reference	1.00	ref.	1.00	Reference	1.00	Reference	1.00	Reference	1.00	Reference
2001–2004	0.88	(0.72–1.08)	1.00	(0.77–1.29)	1.00	(0.66–1.51)	1.06	(0.68–1.65)	1.11	(0.89–1.39)	0.97	(0.69–1.37)
2005–2007	0.74	(0.56–0.97)	0.80	(0.58–1.11)	0.88	(0.51–1.51)	0.86	(0.50–1.50)	0.61	(0.42–0.87)	0.60	(0.35–1.02)
2008–2010	0.61	(0.40–0.94)	0.80	(0.39–1.62)	0.45	(0.16–1.28)	0.46	(0.06–3.54)	0.49	(0.27–0.88)	0.20	(0.03–1.52)
Age at diagnosis
0–59	1.00	Reference	1.00	Reference	–	–	–	–	–	–	–	–
60–69	1.25	(0.92–1.70)	1.05	(0.70–1.56)	–	–	–	–	–	–	–	–
70–79	2.01	(1.52–2.66)	1.62	(1.12–2.32)	–	–	–	–	–	–	–	–
≥80	3.60	(2.68–4.83)	2.54	(1.73–3.73)	–	–	–	–	–	–	–	–
ASA classification
1	1.00	Reference	1.00	Reference	–	–	–	–	–	–	–	–
2	1.83	(1.31–2.56)	1.76	(1.08–2.85)	–	–	–	–	–	–	–	–
3	2.91	(2.05–4.12)	2.20	(1.32–3.67)	–	–	–	–	–	–	–	–
4	4.53	(2.78–7.39)	2.99	(1.61–5.54)	–	–	–	–	–	–	–	–
Epidural anaesthesia
No	1.00	Reference	1.00	Reference	–	–	–	–	–	–	–	–
Yes	0.50	(0.39–0.64)	0.79	(0.57–1.09)	–	–	–	–	–	–	–	–
Type of surgery
Emergency	1.00	Reference	1.00	Reference	–	–	–	–	–	–	–	–
Elective	0.51	(0.40–0.64)	0.61	(0.45–0.81)	–	–	–	–	–	–	–	–
Cardiac failure
No history	–	–	–	–	–	–	–	–	1.00	Reference	1.00	Reference
Positive history	–	–	–	–	–	–	–	–	3.24	(2.51–4.19)	2.98	(2.17–4.11)
Anaesthesia duration	1.00	(1.00–1.00)	1.00	(1.00–1.01)	–	–	–	–	1.00	(1.00–1.01)	1.00	(0.99–1.02)
Blood loss	–	–	–	–	–	–	–	–	1.01	(1.01–1.01)	1.00	(1.00–1.00)
Stage at diagnosis
I	–	–	–	–	–	–	–	–	1.00	Reference	1.00	Reference
II	–	–	–	–	–	–	–	–	2.97	(2.27–3.90)	2.61	(1.90–3.57)
III	–	–	–	–	–	–	–	–	8.57	(5.83–12.59)	5.67	(3.61–8.90)
IV	–	–	–	–	–	–	–	–	10.59	(6.13–18.29)	6.80	(3.61–12.85)
Nitrous oxide
Yes	–	–	–	–	–	–	–	–	1.00	Reference	1.00	Reference
No	–	–	–	–	–	–	–	–	0.88	(0.70–1.10)	1.03	(0.72–1.46)

ASA = American Society of Anesthesiologists; CI = confidence interval; HR = Cox proportion hazard ratio; HR in italic = adjusted for propensity scores.