Effects of general anesthesia versus local anesthesia in primary hepatocellular carcinoma patients presenting for thermal ablation surgery: a multiple center retrospective cohort study with propensity score matching

Xiaoqiang Wang; Weiying Xie; Shuyuan Gan; Tao Wang; Xuexin Chen; Diansan Su; Jiaxin Sun; Jiapiao Lin; Feixiang Wu; Pingbo Xu; Changhong Miao; Min Yan; Shengmei Zhu; Bo Zhai; Yuming Sun; Weifeng Yu; Jie Tian

doi:10.21037/atm.2020.03.88

Effects of general anesthesia versus local anesthesia in primary hepatocellular carcinoma patients presenting for thermal ablation surgery: a multiple center retrospective cohort study with propensity score matching

Ann Transl Med. 2020 Mar;8(6):277. doi: 10.21037/atm.2020.03.88.

Authors

Xiaoqiang Wang¹, Weiying Xie², Shuyuan Gan³, Tao Wang⁴, Xuexin Chen⁵, Diansan Su¹, Jiaxin Sun⁶, Jiapiao Lin³, Feixiang Wu⁷, Pingbo Xu⁸, Changhong Miao⁸, Min Yan², Shengmei Zhu³, Bo Zhai⁴, Yuming Sun⁷, Weifeng Yu¹, Jie Tian¹

Affiliations

¹ Department of Anesthesiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
² Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China.
³ Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China.
⁴ Department of Interventional Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
⁵ Department of Anesthesiology, Cancer Hospital, The General Hospital of Ningxia Medical University, Ningxia 750004, China.
⁶ Department of Anesthesiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China.
⁷ Department of Anesthesiology & Intensive Care, Eastern Hepatobiliary Hospital, The Nary Military Medical University, Shanghai 200438, China.
⁸ Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.

Abstract

Background: Whether anesthesia methods affect the prognosis of tumor patients is controversial. With the aim of comparing the effects of general anesthesia (GA) and local anesthesia (LA) in primary hepatocellular carcinoma (HCC) patients presenting for elective thermal ablation (TA) surgeries, a multiple center retrospective cohort study was designed and implemented.

Methods: Patients who received elective TA surgery under GA or LA from Jan. 2014 to Dec. 2016 and met the eligibility criteria were included. Survival analysis was used to identify the influence of anesthesia methods on recurrence-free survival (RFS) and overall survival (OS). Propensity score matching (PSM) was used to minimize the bias between the GA group and the LA group.

Results: A total of 244 patients with GA and 245 with LA were eligible for analysis. After PSM, 178 patients remained in each group. In the matched groups, GA showed a significantly higher recurrence rate compared with LA by both the Kaplan-Meier survival analyses (P=0.011) and multivariable Cox regression analyses (P=0.002). The multivariable Cox regression model also revealed that GA had a hazard ratio (HR) of 1.746 (P=0.036) for death compared with the LA group.

Conclusions: GA is associated with decreased RFS and OS after surgery compared with LA in HCC patients undergoing TA surgery. Prospective trials exploring the effects of different anesthetic methods on cancer outcome in these patients are warranted.

Keywords: Hepatocellular carcinoma (HCC); anesthesia methods; propensity score matching (PSM); recurrence-free survival (RFS); thermal ablation (TA).