SummaryBackgroundWhile evidence from preclinical and observational cohort studies have suggested potential disparities in tumour behaviour associated with the choice of intra‐operative anaesthetics, clinical evidence of tumour recurrence and metastasis remains inconclusive. We aimed to compare the impact of intra‐operative anaesthesia on oncologic outcomes following hepatectomy for hepatocellular carcinoma.MethodsAdult patients scheduled for elective hepatectomy for hepatocellular carcinoma were assigned randomly (1:1) to either propofol‐based total intravenous anaesthesia or sevoflurane‐based inhalational anaesthesia. For recurrence‐free survival, overall survival, intrahepatic recurrence‐free survival and extrahepatic recurrence‐free survival, the survival curves of the two groups were estimated using the Kaplan–Meier method and compared with the log‐rank test. The primary outcome was one‐year recurrence‐free survival.ResultsAmong the 536 patients enrolled, primary analysis comprised 228 and 226 patients in the total intravenous anaesthesia and sevoflurane‐based inhalational anaesthesia groups, respectively. The probability of recurrence‐free survival at one year was 79.1% (47 events) and 77.7% (50 events) in the total intravenous anaesthesia and sevoflurane‐based inhalational anaesthesia groups, respectively (adjusted hazard ratio 1.04, 95%CI 0.72–1.52). The probability of intrahepatic and extrahepatic recurrence‐free survival, as well as overall survival at one year, was not significantly different between total intravenous anaesthesia and sevoflurane‐based inhalational anaesthesia: 81.3% (42 events) vs. 81.7% (41 events); 91.5% (19 events) vs. 88.8% (25 events); 99.1% (2 events) vs. 100.0% (no event), respectively. Subgroup analyses revealed that in patients undergoing open hepatectomy, total intravenous anaesthesia was associated with a significantly lower hazard of tumour recurrence or death (hazard ratio 0.49, 95%CI 0.25–0.95, p = 0.034), while in patients undergoing laparoscopic surgery, no significant difference was observed (hazard ratio 1.14, 95%CI 0.73–1.80, p = 0.558).DiscussionIntra‐operative anaesthesia technique did not affect postoperative recurrence and overall survival in patients with hepatocellular carcinoma undergoing hepatectomy.

中文翻译：

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使用基于异丙酚的全静脉麻醉和基于七氟烷的吸入麻醉进行肝切除术后的无复发生存期：一项随机对照研究


摘要背景虽然临床前和观察性队列研究的证据表明，与术中麻醉剂的选择相关的肿瘤行为存在潜在差异，但肿瘤复发和转移的临床证据仍无定论。我们旨在比较术中麻醉对肝细胞癌肝切除术后肿瘤结局的影响。方法计划接受肝细胞癌择期肝切除术的成年患者被随机 （1：1） 分配到基于异丙酚的全静脉麻醉组或基于七氟烷的吸入麻醉组。对于无复发生存期、总生存期、肝内无复发生存期和肝外无复发生存期，使用 Kaplan-Meier 方法估计两组的生存曲线，并与对数秩检验进行比较。主要结局是 1 年无复发生存期。结果在入组的 536 例患者中，主要分析分别包括总静脉麻醉组和基于七氟烷的吸入麻醉组的 228 例和 226 例患者。总静脉麻醉组和基于七氟烷的吸入麻醉组一年无复发生存率分别为 79.1% （47 个事件） 和 77.7% （50 个事件） （校正风险比 1.04,95% CI 0.72-1.52）。全静脉麻醉和基于七氟烷的吸入麻醉之间的肝内和肝外无复发生存率以及一年总生存率没有显著差异：81.3%（42 个事件）对 81.7%（41 个事件）;91.5%（19 个事件）对 88.8%（25 个事件）;分别为 99.1%（2 个事件）和 100.0%（无事件）。 亚组分析显示，在接受开腹肝切除术的患者中，全静脉麻醉与肿瘤复发或死亡风险显著降低相关 （风险比 0.49,95%CI 0.25-0.95，p = 0.034），而在接受腹腔镜手术的患者中，未观察到显著差异 （风险比 1.14,95% CI 0.73-1.80，p = 0.558）。讨论术中麻醉技术不影响肝切除术肝细胞癌患者的术后复发和总生存期。