Long-term Survival after Volatile or Propofol General Anesthesia for Bladder Cancer Surgery: A Retrospective National Registry Cohort Study

• Published in: Anesthesiology (Philadelphia) Vol. 140; no. 6; pp. 1126 - 1133
• Main Authors: Enlund, Mats, Hållberg, Hampus, Berglund, Anders, Sherif, Amir, Enlund, Anna, Bergkvist, Leif
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01.06.2024
• Subjects: Aged; Aged, 80 and over; Anesthesia, General - methods; Anesthesia, General - mortality; Anesthetics, Inhalation - administration & dosage; Anesthetics, Intravenous - administration & dosage; Cohort Studies; Female; Humans; Male; Middle Aged; Propofol - administration & dosage; Registries; Retrospective Studies; Survival Rate - trends; Sweden - epidemiology; Urinary Bladder Neoplasms - mortality; Urinary Bladder Neoplasms - surgery; Sweden
• ISSN: 0003-3022; 1528-1175; 1528-1175
• DOI: 10.1097/ALN.0000000000004969

Background Prospective interventional trials and retrospective observational analyses provide conflicting evidence regarding the relationship between propofol versus inhaled volatile general anesthesia and long-term survival after cancer surgery. Specifically, bladder cancer surgery lacks prospective clinical trial evidence. Methods Data on bladder cancer surgery performed under general anesthesia between 2014 and 2021 from the National Quality Registry for Urinary Tract and Bladder Cancer and the Swedish Perioperative Registry were record-linked. Overall survival was compared between patients receiving propofol or inhaled volatile for anesthesia maintenance. The minimum clinically important difference was defined as a 5–percentage point difference in 5-yr survival. Results Of 7,571 subjects, 4,519 (59.7%) received an inhaled volatile anesthetic, and 3,052 (40.3%) received propofol for general anesthesia maintenance. The two groups were quite similar in most respects but differed in American Society of Anesthesiologists Physical Status and tumor stage. Propensity score matching was used to address treatment bias. Survival did not differ during follow-up (median, 45 months [interquartile range, 33 to 62 months]) in the full unmatched cohort nor after 1:1 propensity score matching (3,052 matched pairs). The Kaplan–Meier adjusted 5-yr survival rates in the matched cohort were 898 of 3,052, 67.5% (65.6 to 69.3%) for propofol and 852 of 3,052, 68.5% (66.7 to 70.4%) for inhaled volatile general anesthesia, respectively (hazard ratio, 1.05 [95% CI, 0.96 to 1.15]; P = 0.332). A sensitivity analysis restricted to 1,766 propensity score–matched pairs of patients who received only one general anesthetic during the study period did not demonstrate a difference in survival; Kaplan–Meier adjusted 5-yr survival rates were 521 of 1,766, 67.1% (64.7 to 69.7%) and 482 of 1,766, 68.9% (66.5 to 71.4%) for propofol and inhaled volatile general anesthesia, respectively (hazard ratio, 1.09 [95% CI, 0.97 to 1.23]; P = 0.139). Conclusions Among patients undergoing bladder cancer surgery under general anesthesia, there was no statistically significant difference in long-term overall survival associated with the choice of propofol or an inhaled volatile maintenance. Editor’s Perspective What We Already Know about This Topic Prospective interventional studies comparing propofol versus inhaled volatile general anesthesia for a range of cancer surgeries have not demonstrated superiority of one technique to prevent cancer recurrence or mortality However, specific to bladder cancer surgery, the association between propofol versus inhaled general anesthesia and cancer recurrence or long-term survival remains unclear What This Article Tells Us That Is New Data combining two national Swedish clinical registries from 2014 to 2021 for 7,571 cancer surgery patients demonstrated that 4,519 (59.7%) received inhaled volatile general anesthesia and 3,052 (40.3%) received propofol general anesthesia In a propensity score–matched cohort of 6,104 patients, there was no statistically significant difference in the Kaplan–Meier adjusted 5-yr survival rates for patients receiving inhaled volatile (68.5%) versus propofol (67.5%) general anesthesia Data combining two national Swedish clinical registries from 2014 to 2021 for 7,571 cancer surgery patients demonstrated that 4,519 (59.7%) received inhaled volatile general anesthesia and 3,052 (40.3%) received propofol general anesthesia. In a propensity score–matched cohort of 6,104 patients, there was no statistically significant difference in the Kaplan–Meier adjusted 5-yr survival rates for patients receiving inhaled volatile (68.5%) versus propofol (67.5%) general anesthesia.