Survival after primary breast cancer surgery following propofol or sevoflurane general anesthesia—A retrospective, multicenter, database analysis of 6305 Swedish patients

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Background: Retrospective studies indicate that the choice of anesthetic can affect long-term cancer survival. Propofol seems to have an advantage over sevoflurane. However, this is questioned for breast cancer. We gathered a large cohort of breast cancer surgery patients from seven Swedish hospitals and hypothesized that general anesthesia with propofol would be superior to sevoflurane anesthesia regarding long-term breast cancer survival. Methods: We identified all patients who were anaesthetized for breast cancer surgery between 2006 and 2012. The patients were matched to the Swedish Breast Cancer Quality Register, to retrieve tumor characteristics, prognostic factors, and adjuvant treatment as well as date of death. Overall survival between patients undergoing sevoflurane and propofol anesthesia was analyzed with different statistical approaches: (a) multiple Cox regression models adjusted for demographic, oncological, and multiple control variables, (b) propensity score matching on the same variables, but also including the participating centers as a cofactor in a separate analysis. Results: The database analysis identified 6305 patients. The 5-year survival rates were 91.0% and 81.8% for the propofol and sevoflurane group, respectively, in the final model (P =.126). Depending on the statistical adjustment method used, different results were obtained, from a non-significant to a "proposed" and even a "determined" difference in survival that favored propofol, with a maximum of 9.2 percentage points higher survival rate at 5 years (hazard ratio 1.46, 95% CI 1.10-1.95). Conclusions: It seems that propofol may have a survival advantage compared with sevoflurane among breast cancer patients, but the inherent weaknesses of retrospective analyses were made apparent.


  • Mats Enlund
  • Anders Berglund
  • Rebecca Ahlstrand
  • Jakob Walldén
  • Johan Lundberg
  • Fredrik Wärnberg
  • Andreas Ekman
  • Nina Sjöblom Widfeldt
  • Anna Enlund
  • Leif Bergkvist
Enheter & grupper
Externa organisationer
  • Uppsala universitet
  • Örebro University Hospital
  • Umeå University
  • Skåne University Hospital
  • Kalmar County Hospital
  • Västra Götalandsregionen
  • EpiStat (Epidemiology & Statistics Consulting) Sweden

Ämnesklassifikation (UKÄ) – OBLIGATORISK

  • Cancer och onkologi
Sidor (från-till)1048-1054
Antal sidor7
TidskriftActa Anaesthesiologica Scandinavica
Utgåva nummer8
Tidigt onlinedatum2020
StatusPublished - 2020 sep
Peer review utfördJa