Association of Volatile Versus Intravenous Anesthesia With Prognosis After Nephrectomy for Renal Cell Carcinoma

A recent preclinical study reported that renal cell carcinoma was more susceptible to sevoflurane-mediated metastatic potentiation, compared to non-small cell lung cancer, suggesting that the effect of anesthetic agents on the metastatic potential varies according to cancer type. Based on this report, we conducted a retrospective cohort study to compare recurrence-free survival after nephrectomy, between renal cell carcinoma patients receiving volatile anesthesia and those receiving intravenous anesthesia.

We reviewed the electronic medical records of patients who underwent partial or radical nephrectomy for renal cell carcinoma at the Seoul National University Hospital. Patients were divided into two groups according to whether volatile or intravenous anesthesia was used for nephrectomy. A total of 651 patients (582 in the volatile and 69 in the intravenous group) were enrolled in the study. Recurrence-free survival after nephrectomy was compared using Cox proportional hazards regression analysis with inverse probability of treatment weighting.

Cox regression analysis with inverse probability of treatment weighting revealed that volatile anesthesia had no impact on recurrence-free survival [hazard ratio (HR)=0.45; 95% confidence interval (CI)=0.07-2.85; p=0.398] or overall survival (HR=1.41; 95% CI=0.31-6.44; p=0.661).

We found no significant association between volatile anesthesia and poor outcomes after nephrectomy for renal cell carcinoma. Volatile anesthetic-promoted metastatic potentiation of renal cell carcinoma, shown in a preclinical study, does not seem to be translated in the clinical setting.