No overall survival difference but elevated risk in specific subgroups: a retrospective cohort study of total intravenous anesthesia versus intravenous-inhalation combined anesthesia in patients undergoing radical hepatectomy for hepatocellular carcinoma

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 propofolbased 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.