Recurrence-free survival after hepatectomy using propofol-based total intravenous anaesthesia and sevoflurane-based inhalational anaesthesia: a randomised controlled study.

Summary

In a randomized trial of 454 analyzed HCC hepatectomy patients, propofol TIVA did not improve 1‑year recurrence-free or overall survival versus sevoflurane anesthesia. A prespecified subgroup showed benefit of TIVA in open (but not laparoscopic) hepatectomy, suggesting surgical approach may modify any anesthetic effect.

Key Findings

• One-year recurrence-free survival was similar: 79.1% (TIVA) vs 77.7% (sevoflurane), adjusted HR 1.04 (95% CI 0.72–1.52).
• No differences in intrahepatic/extrahepatic recurrence-free survival or overall survival at 1 year.
• Open hepatectomy subgroup favored TIVA (HR 0.49; 95% CI 0.25–0.95), whereas laparoscopic cases showed no difference.

Clinical Implications

Routine switching to TIVA solely to reduce HCC recurrence after hepatectomy is not supported overall. For open hepatectomy, TIVA may be considered, but the subgroup finding should be interpreted cautiously and validated.

Limitations

• Subgroup benefit in open surgery is exploratory and may be underpowered; risk of type I error.
• Follow-up limited to 1 year for primary endpoint; generalizability confined to HCC hepatectomy.

Future Directions

Multicenter RCTs stratified by surgical approach (open vs laparoscopic) and longer follow-up are needed to validate the subgroup signal and assess long-term oncologic outcomes.