BACKGROUND Several retrospective studies using administrative or single-center data have failed to show any difference between general anesthesia using propofol versus inhaled volatiles on long-term survival after breast cancer surgery. Although randomized controlled trials are ongoing, validated data from national clinical registries may advance the reliability of existing knowledge. METHODS Data on breast cancer surgery performed under general anesthesia between 2013 and 2019 from the Swedish PeriOperative Registry and the National Quality Registry for Breast Cancer were record-linked. Overall survival was compared between patients receiving propofol and patients receiving inhaled volatile for anesthesia maintenance. RESULTS Of 18,674 subjects, 13,873 patients (74.3%) received propofol and 4,801 (25.7%) received an inhaled volatile for general anesthesia maintenance. The two cohorts differed in most respects. Patients receiving inhaled volatile were older (67 yr vs. 65 yr), sicker (888 [19.0%] American Society of Anesthesiologists status 3 to 5 vs. 1,742 [12.8%]), and the breast cancer to be more advanced. Median follow-up was 33 months (interquartile range, 19 to 48). In the full, unmatched cohort, there was a statistically significantly higher overall survival among patients receiving propofol (13,489 of 13,873 [97.2%]) versus inhaled volatile (4,039 of 4,801 [84.1%]; hazard ratio, 0.80; 95% CI, 0.70 to 0.90; P < 0.001). After 1:1 propensity score matching (4,658 matched pairs), there was no statistically significant difference in overall survival (propofol 4,284 of 4,658 [92.0%]) versus inhaled volatile (4,288 of 4,658 [92.1%]; hazard ratio, 0.98; 95% CI, 0.85 to 1.13; P = 0.756). CONCLUSIONS Among patients undergoing breast cancer surgery under general anesthesia, no association was observed between the choice of propofol or an inhaled volatile maintenance and overall survival. EDITOR’S PERSPECTIVE

中文翻译：

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挥发性与丙泊酚全身麻醉和乳腺癌手术后的长期生存：一项国家注册回顾性队列研究。

背景 几项使用行政或单中心数据的回顾性研究未能显示使用丙泊酚的全身麻醉与吸入挥发物对乳腺癌手术后长期生存率的任何差异。尽管随机对照试验正在进行中，但来自国家临床登记处的经过验证的数据可能会提高现有知识的可靠性。方法 瑞典围手术期登记处和国家乳腺癌质量登记处 2013 年至 2019 年间在全身麻醉下进行的乳腺癌手术数据与记录相关。比较了接受异丙酚的患者和接受吸入挥发性麻醉剂维持麻醉的患者的总生存期。结果 在 18,674 名受试者中，13,873 名患者 (74.3%) 接受了丙泊酚，4,801 名患者 (25. 7%）接受吸入挥发物进行全身麻醉维持。这两个群体在大多数方面都不同。接受吸入挥发物的患者年龄较大（67 岁对 65 岁），病情较重（888 [19.0%] 美国麻醉医师协会状态 3 至 5 对 1,742 [12.8%]），并且乳腺癌更晚期。中位随访时间为 33 个月（四分位距，19 至 48）。在完整的、无与伦比的队列中，接受异丙酚的患者（13,873 名中的 13,489 名 [97.2%]）与吸入挥发物（4,801 名中的 4,039 名 [84.1%]）相比，总生存率显着更高；风险比，0.80；95% CI，0.70至 0.90；P < 0.001）。经过 1:1 倾向评分匹配（4,658 对匹配）后，总生存率（4,658 人中的 4,284 人 [92.0%]）与吸入挥发物（4,658 人中的 4,288 人 [92.1%]）没有统计学显着差异；风险比，0.98；95% CI，0.85 至 1.13；P = 0.756）。结论 在全身麻醉下接受乳腺癌手术的患者中，未观察到丙泊酚或吸入性挥发性维持剂的选择与总生存期之间存在关联。编辑观点