Full
Outline
To investigate the impact of propofol-based total intravenous anesthesia(TIVA) versus sevoflurane-propofol intravenous-inhalation combined anesthesia(IICA) on 5-year postoperative survival rates in patients undergoing radical hepatectomy for hepatocellular carcinoma(HCC).
A retrospective cohort study was conducted on the clinical and follow-up data from 504 patients undergoing radical HCC surgery in our hospital between January 2015 and December 2017. According to different anesthesia techniques, the patients were divided into a IICA groups(n=176) and a TIVA group(n=328). The 5-year postoperative survival rates were compared between the 2 groups of patients. Stratified analyses were carried out by age, tumor size and number, Child-Pugh class and model for end-stage liver disease(MELD) score, presence of portal vein tumor thrombus(PVTT), intraoperative transfusion, hepatitis B surface antigen status, alpha-fetoprotein(AFP), tumor node metastasis(TNM) stage, and Barcelona clinic liver cancer(BCLC) stage to compare the impact of the 2 anesthesia methods on postoperative survival rates in subgroups.
Among the cohort, the median 5-year survival was 33.00(14.25 to 60.00) months in the TIVA group with 212 deaths(64.60%), and 27.00(11.00 to 60.00) months in the IICA group with 125 deaths(71.00%). There was no statistically significant difference in 5-year survival rate between groups(HR=1.27, 95%CI: 0.96 to 1.67, P>0.05). Stratified analysis revealed significant increased 5-year mortality risk with CIVA in subgroups with MELD score >7.24(HR=1.61, 95%CI: 1.11 to 2.32, P=0.011), BCLC stage B(HR=1.74, 95%CI: 1.11 to 2.71, P=0.015), absence of PVTT(HR=1.35, 95%CI: 1.04 to 1.74, P=0.026), and no intraoperative transfusion(HR=1.34, 95%CI: 1.02 to 1.75, P=0.034).
Among patients undergoing radical hepatectomy for HCC, there is no difference in 5-year overall survival between propofol-based TIVA and sevoflurane-propofol IICA. However, IICA is associated with significantly increased 5-year mortality risk in specific subgroups: MELD score >7.24, absence of PVTT, BCLC stage B, and no intraoperative transfusion.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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