Intraoperative fractions of inspiratory oxygen are associated with recurrence-free survival after elective cancer surgery
Background: Choice of the fraction of inspiratory oxygen (FiO2) is controversial. The objective of this analysis was to evaluate whether intraoperative FiO2 was associated with recurrence-free survival after elective cancer surgery.Methods and Analysis: In this single-center, retrospective study, we...
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| Main Authors: | , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
26 November 2021
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| In: |
Frontiers in medicine
Year: 2021, Volume: 8, Pages: 1-12 |
| ISSN: | 2296-858X |
| DOI: | 10.3389/fmed.2021.761786 |
| Online Access: | Resolving-System, kostenfrei, Volltext: https://doi.org/10.3389/fmed.2021.761786 Verlag, kostenfrei, Volltext: https://www.frontiersin.org/article/10.3389/fmed.2021.761786 
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| Author Notes: | Sarah Dehne, Verena Spang, Rosa Klotz, Laura Kummer, Samuel Kilian, Katrin Hoffmann, Martin A. Schneider, Thilo Hackert, Markus W. Büchler, Markus A. Weigand and Jan Larmann |
| Summary: | Background: Choice of the fraction of inspiratory oxygen (FiO2) is controversial. The objective of this analysis was to evaluate whether intraoperative FiO2 was associated with recurrence-free survival after elective cancer surgery.Methods and Analysis: In this single-center, retrospective study, we analyzed 1,084 patients undergoing elective resection of pancreatic (n = 652), colorectal (n = 405), or hepatic cancer (n = 27) at Heidelberg University Hospital between 2009 and 2016. Intraoperative mean FiO2 values were calculated. For unstratified analyses, the study cohort was equally divided into a low- and a high-FiO2 group. For cancer-stratified analyses, this division was done within cancer-strata. The primary outcome measure was recurrence-free survival until the last known follow-up. Groups were compared using Kaplan-Meier analysis. A stratified log rank test was used to control for different FiO2 levels and survival times between the cancer strata. Cox-regression analyses were used to control for covariates. Sepsis, reoperations, surgical-site infections, and cardiovascular events during hospital stay and overall survival were secondary outcomes.Results: Median FiO2 was 40.9% (Q1-Q3, 38.3-42.9) in the low vs. 50.4% (Q1-Q3, 47.4-54.7) in the high-FiO2 group. Median follow-up was 3.28 (Q1-Q3, 1.68-4.97) years. Recurrence-free survival was considerable higher in the high-FiO2 group (p < 0.001). This effect was also confirmed when stratified for the different tumor entities (p = 0.007). In colorectal cancer surgery, increased FiO2 was independently associated with increased recurrence-free survival. The hazard for the primary outcome decreased by 3.5% with every 1% increase in FiO2. The effect was not seen in pancreatic cancer surgery and we did not find differences in any of the secondary endpoints.Conclusions: Until definite evidence from large-scale trials is available and in the absence of relevant clinical conditions warranting specific FiO2 values, perioperative care givers should aim for an intraoperative FiO2 of 50% in abdominal cancer surgery as this might benefit oncological outcomes. |
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| Item Description: | Gesehen am 08.02.2022 |
| Physical Description: | Online Resource |
| ISSN: | 2296-858X |
| DOI: | 10.3389/fmed.2021.761786 |