303P - Long-term oncologic outcomes for patients undergoing volatile versus intravenous anesthesia for non-small cell lung cancer surgery

Background

Propofol-based total intravenous anesthesia (TIVA) has been reported to improve long-term outcomes following cancer surgery when compared with inhalation agents. However, such investigational reports are still controversial, especially in non-small cell lung cancer surgery. This study aimed to compare the oncologic outcome of TIVA versus inhalation agents on recurrence-free survival and overall survival after curative resection of early-stage NSCLC.

Methods

This retrospective cohort study examined medical records of the patients who were diagnosed with stage I or II NSCLC and underwent curative resection at Seoul St. Mary's Hospital from January 2010 and December 2017. The primary objectives were to evaluate the survival outcomes according to anesthesia type during curative lung cancer resection.

Results

This study included 1508 cases of stage I/II NSCLC which were divided into the TIVA group (N=980) and inhalation group (N=528). Two groups were well balanced in terms of baseline clinical factors such as age, underlying diseases and surgery type. Patients who received TIVA during curative surgery showed a better disease-free survival (DFS) of 7.7 years (95% confidence interval [CI], 7.37-8.02) than those who received inhalation anesthesia. P, who had a DFS of 6.8 years (95% CI, 6.30-7.22, P = 0.003). Also, in terms of overall survival (OS), TIVA was superior to inhalation agents (median OS, 8.4 years; 95% CI, 8.08-8.69 vs. 7.3 years; 95% CI, 6.81-7.71; P < 0.0001). Factors significantly related to DFS in univariate Cox regression were age, sex, BMI, ASA classification, smoking history, hypertension, surgery type, stage, and anesthesia type. In multivariate analysis, TIVA was an independent prognostic factor associated with recurrence (HR 1.21, 95% CI 1.00-1.46, p = 0.046). TIVA was also an independent prognostic factor for OS in multivariate analysis (HR 1.32, 95% CI 1.07-1.62, p < 0.001).

Conclusions

Propofol-based TIVA showed better DFS and OS in 1508 patients with stage I/II NSCLC who received curative resection than inhalation agents. The results of this retrospective study in a single institution provide evidence for a prospective randomized multicenter study.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Catholic Medical Center Research Foundation made in the program year of 2020.

Disclosure

All authors have declared no conflicts of interest.