Intraoperative fractions of inspiratory oxygen are associated with recurrence-free survival after elective cancer surgery

• Verfasst von: Dehne, Sarah [VerfasserIn]
• Verfasst von: Spang, Verena [VerfasserIn]
• Verfasst von: Klotz, Rosa [VerfasserIn]
• Verfasst von: Kummer, Laura [VerfasserIn]
• Verfasst von: Kilian, Samuel [VerfasserIn]
• Verfasst von: Hoffmann, Katrin [VerfasserIn]
• Verfasst von: Schneider, Martin [VerfasserIn]
• Verfasst von: Hackert, Thilo [VerfasserIn]
• Verfasst von: Büchler, Markus W. [VerfasserIn]
• Verfasst von: Weigand, Markus A. [VerfasserIn]
• Verfasst von: Larmann, Jan [VerfasserIn]
• Titel: Intraoperative fractions of inspiratory oxygen are associated with recurrence-free survival after elective cancer surgery
• Verf.angabe: 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
• E-Jahr: 2021
• Jahr: 26 November 2021
• Umfang: 12 S.
• Fussnoten: Gesehen am 08.02.2022
• Titel Quelle: Enthalten in: Frontiers in medicine
• Ort Quelle: Lausanne : Frontiers Media, 2014
• Jahr Quelle: 2021
• Band/Heft Quelle: 8(2021) vom: Nov., Artikel-ID 761786, Seite 1-12
• ISSN Quelle: 2296-858X
• DOI: doi:10.3389/fmed.2021.761786
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1788904893
• K10plus-PPN:
  Universitätsbibliothek
• Lokale URL UB: Zum Volltext

Abstract

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.