Recurrence‐free survival after hepatectomy using propofol‐based total intravenous anaesthesia and sevoflurane‐based inhalational anaesthesia: a randomised controlled study

Summary Background While 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. Methods Adult 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. Results Among 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). Discussion Intra‐operative anaesthesia technique did not affect postoperative recurrence and overall survival in patients with hepatocellular carcinoma undergoing hepatectomy.