Comparison of Biochemical Recurrence After Robot-assisted Laparoscopic Radical Prostatectomy with Volatile and Total Intravenous Anesthesia

• Published in: International journal of medical sciences 2020-01, Vol.17 (4), p.449-456
• Main Authors: Kim, Na Young, Jang, Won Sik, Choi, Young Deuk, Hong, Jung Hwa, Noh, Sewon, Yoo, Young-Chul
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia; Anesthesia, Intravenous - methods; Blood pressure; Cancer surgery; Carbon dioxide; Clinical trials; Disease-Free Survival; Humans; Laparoscopy; Laparoscopy - methods; Male; Medical prognosis; Middle Aged; Multivariate Analysis; Proportional Hazards Models; Prospective Studies; Prostate cancer; Prostatectomy - methods; Prostatic Neoplasms - surgery; Research Paper; Robotic Surgical Procedures - methods; Robotics; Surgical outcomes; Urological surgery
• ISSN: 1449-1907; 1449-1907
• DOI: 10.7150/ijms.40958

: Recurrence after cancer surgery is a major concern in patients with cancer. Growing evidence from preclinical studies has revealed that various anesthetics can influence the immune system in different ways. The current study compared the long-term biochemical recurrence of prostate cancer after robot-assisted laparoscopic radical prostatectomy (RALP) in terms of selection of anesthetic agent between total intravenous anesthesia (TIVA) with propofol/remifentanil and volatile anesthetics (VA) with sevoflurane or desflurane/remifentanil. : We followed up oncologic outcomes of patients who underwent RALP from two previous prospective randomized controlled trials, and the outcomes of those who received TIVA (n = 64) were compared with those who received VA (n = 64). The follow-up period lasted from November 2010 to March 2019. : Both TIVA and VA groups showed identical biochemical recurrence-free survivals at all-time points after RALP. The following predictive factors of prostate cancer recurrence were determined by Cox regression: colloid input [hazard ratio (HR)=1.002, 95% confidence interval (CI): 1.000-1.003; P = 0.011], initial prostate-specific antigen level (HR=1.025, 95% CI: 1.007-1.044; P = 0.006), and pathological tumor stage 3b (HR=4.217, 95% CI:1.207-14.735; P = 0.024), but not the anesthetic agent. : Our findings demonstrate that both TIVA with propofol/remifentanil and VA with sevoflurane or desflurane/remifentanil have comparable effects on oncologic outcomes in patients undergoing RALP.