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Propofol vs sevoflurane and breast cancer survival
In the CAN randomised trial, five-year overall survival after primary breast cancer surgery was essentially the same with propofol or sevoflurane maintenance anaesthesia.
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What comparison did the CAN breast-cancer trial test?
Propofol versus sevoflurane for maintenance of general anaesthesia during curative primary breast cancer surgery.
Source: Impact of general anaesthesia on breast cancer survival: a 5-year follow up of a pragmatic, randomised, controlled trial, the CAN-study, comparing propofol and sevoflurane · DOI · quote verified
What was the primary outcome?
Five-year overall survival.
Source: Impact of general anaesthesia on breast cancer survival: a 5-year follow up of a pragmatic, randomised, controlled trial, the CAN-study, comparing propofol and sevoflurane · DOI · quote verified
How many patients remained in the ITT analysis?
1670 patients (841 propofol, 829 sevoflurane).
Source: Impact of general anaesthesia on breast cancer survival: a 5-year follow up of a pragmatic, randomised, controlled trial, the CAN-study, comparing propofol and sevoflurane · DOI · quote verified
What were the five-year survival rates by arm?
About 91.9% with propofol and 92.2% with sevoflurane.
Source: Impact of general anaesthesia on breast cancer survival: a 5-year follow up of a pragmatic, randomised, controlled trial, the CAN-study, comparing propofol and sevoflurane · DOI · quote verified
What did the ITT hazard ratio show?
HR about 1.03 with a wide confidence interval crossing 1 (P = 0.875), indicating no significant difference.
Source: Impact of general anaesthesia on breast cancer survival: a 5-year follow up of a pragmatic, randomised, controlled trial, the CAN-study, comparing propofol and sevoflurane · DOI · quote verified
How was randomisation ratio set?
1:1 allocation to propofol or sevoflurane maintenance.
Source: Impact of general anaesthesia on breast cancer survival: a 5-year follow up of a pragmatic, randomised, controlled trial, the CAN-study, comparing propofol and sevoflurane · DOI · quote verified
What was a noted baseline imbalance?
Triple-negative receptor status was more common in the propofol group.
Source: Impact of general anaesthesia on breast cancer survival: a 5-year follow up of a pragmatic, randomised, controlled trial, the CAN-study, comparing propofol and sevoflurane · DOI · quote verified
How did opioid use differ between arms?
Remifentanil was used more with propofol; fentanyl more with sevoflurane.
Source: Impact of general anaesthesia on breast cancer survival: a 5-year follow up of a pragmatic, randomised, controlled trial, the CAN-study, comparing propofol and sevoflurane · DOI · quote verified
Who was eligible?
Adults scheduled for elective curable invasive primary breast cancer surgery under general anaesthesia.
Source: Impact of general anaesthesia on breast cancer survival: a 5-year follow up of a pragmatic, randomised, controlled trial, the CAN-study, comparing propofol and sevoflurane · DOI · quote verified
Why can’t this alone rewrite guidelines?
Evidence-based medicine typically wants at least two well-conducted RCTs, and mortality is a rare outcome needing large power.
Source: Impact of general anaesthesia on breast cancer survival: a 5-year follow up of a pragmatic, randomised, controlled trial, the CAN-study, comparing propofol and sevoflurane · DOI · quote verified
What does the result imply clinically?
Long-term breast cancer survival appears unaffected by choosing propofol versus sevoflurane for maintenance.
Source: Impact of general anaesthesia on breast cancer survival: a 5-year follow up of a pragmatic, randomised, controlled trial, the CAN-study, comparing propofol and sevoflurane · DOI · quote verified