Sarah Dehne, Lina Kirschner, Rosa Klotz, Samuel Kilian, Christoph W. Michalski, Thilo Hackert, Markus W. Büchler, Markus A. Weigand, Jan Larmann
{"title":"术中潮气末二氧化碳水平与胰腺癌择期手术后无复发生存率无关:一项回顾性队列研究","authors":"Sarah Dehne, Lina Kirschner, Rosa Klotz, Samuel Kilian, Christoph W. Michalski, Thilo Hackert, Markus W. Büchler, Markus A. Weigand, Jan Larmann","doi":"10.3389/fmed.2024.1442283","DOIUrl":null,"url":null,"abstract":"BackgroundIntraoperative end-tidal carbon dioxide concentrations (EtCO<jats:sub>2</jats:sub>) values are associated with recurrence-free survival after colorectal cancer surgery. However, it is unknown if similar effects can be observed after other surgical procedures. There is now evidence available for target EtCO<jats:sub>2</jats:sub> and its relation to surgical outcomes following pancreatic cancer surgery.MethodsIn this single-center, retrospective cohort study, we analyzed 652 patients undergoing elective resection of pancreatic cancer at Heidelberg University Hospital between 2009 and 2016. The entire patient cohort was sorted in ascending order based on mean intraoperative EtCO<jats:sub>2</jats:sub> values and then divided into two groups: the high-EtCO<jats:sub>2</jats:sub> group and the low-EtCO2 group. The pre-specified primary endpoint was the assessment of recurrence-free survival up to the last known follow-up. Cardiovascular events, surgical site infections, sepsis, and reoperations during the hospital stay, as well as overall survival were pre-specified secondary outcomes.ResultsMean EtCO<jats:sub>2</jats:sub> was 33.8 mmHg ±1.1 in the low-EtCO<jats:sub>2</jats:sub> group vs. 36.8 mmHg ±1.9 in the high-EtCO<jats:sub>2</jats:sub> group. Median follow-up was 2.6 (Q1:1.4; Q3:4.4) years. Recurrence-free survival did not differ among the high and low-EtCO<jats:sub>2</jats:sub> groups [HR = 1.043 (95% CI: 0.875–1.243), log rank test: <jats:italic>p</jats:italic> = 0.909]. Factors affecting the primary endpoint were studied via Cox analysis, which indicated no correlation between mean EtCO<jats:sub>2</jats:sub> levels and recurrence-free survival [Coefficient −0.004, HR = 0.996 (95% CI:0.95–1.04); <jats:italic>p</jats:italic> = 0.871]. We did not identify any differences in the secondary endpoints, either.ConclusionsDuring elective pancreatic cancer surgery, anesthesiologists should set EtCO<jats:sub>2</jats:sub> targets for reasons other than oncological outcome until conclusive evidence from prospective, multicenter randomized controlled trials is available.","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":null,"pages":null},"PeriodicalIF":3.1000,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Intraoperative end-tidal carbon dioxide levels are not associated with recurrence-free survival after elective pancreatic cancer surgery: a retrospective cohort study\",\"authors\":\"Sarah Dehne, Lina Kirschner, Rosa Klotz, Samuel Kilian, Christoph W. Michalski, Thilo Hackert, Markus W. Büchler, Markus A. Weigand, Jan Larmann\",\"doi\":\"10.3389/fmed.2024.1442283\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"BackgroundIntraoperative end-tidal carbon dioxide concentrations (EtCO<jats:sub>2</jats:sub>) values are associated with recurrence-free survival after colorectal cancer surgery. However, it is unknown if similar effects can be observed after other surgical procedures. There is now evidence available for target EtCO<jats:sub>2</jats:sub> and its relation to surgical outcomes following pancreatic cancer surgery.MethodsIn this single-center, retrospective cohort study, we analyzed 652 patients undergoing elective resection of pancreatic cancer at Heidelberg University Hospital between 2009 and 2016. The entire patient cohort was sorted in ascending order based on mean intraoperative EtCO<jats:sub>2</jats:sub> values and then divided into two groups: the high-EtCO<jats:sub>2</jats:sub> group and the low-EtCO2 group. The pre-specified primary endpoint was the assessment of recurrence-free survival up to the last known follow-up. Cardiovascular events, surgical site infections, sepsis, and reoperations during the hospital stay, as well as overall survival were pre-specified secondary outcomes.ResultsMean EtCO<jats:sub>2</jats:sub> was 33.8 mmHg ±1.1 in the low-EtCO<jats:sub>2</jats:sub> group vs. 36.8 mmHg ±1.9 in the high-EtCO<jats:sub>2</jats:sub> group. Median follow-up was 2.6 (Q1:1.4; Q3:4.4) years. Recurrence-free survival did not differ among the high and low-EtCO<jats:sub>2</jats:sub> groups [HR = 1.043 (95% CI: 0.875–1.243), log rank test: <jats:italic>p</jats:italic> = 0.909]. Factors affecting the primary endpoint were studied via Cox analysis, which indicated no correlation between mean EtCO<jats:sub>2</jats:sub> levels and recurrence-free survival [Coefficient −0.004, HR = 0.996 (95% CI:0.95–1.04); <jats:italic>p</jats:italic> = 0.871]. We did not identify any differences in the secondary endpoints, either.ConclusionsDuring elective pancreatic cancer surgery, anesthesiologists should set EtCO<jats:sub>2</jats:sub> targets for reasons other than oncological outcome until conclusive evidence from prospective, multicenter randomized controlled trials is available.\",\"PeriodicalId\":12488,\"journal\":{\"name\":\"Frontiers in Medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.1000,\"publicationDate\":\"2024-09-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Frontiers in Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3389/fmed.2024.1442283\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fmed.2024.1442283","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Intraoperative end-tidal carbon dioxide levels are not associated with recurrence-free survival after elective pancreatic cancer surgery: a retrospective cohort study
BackgroundIntraoperative end-tidal carbon dioxide concentrations (EtCO2) values are associated with recurrence-free survival after colorectal cancer surgery. However, it is unknown if similar effects can be observed after other surgical procedures. There is now evidence available for target EtCO2 and its relation to surgical outcomes following pancreatic cancer surgery.MethodsIn this single-center, retrospective cohort study, we analyzed 652 patients undergoing elective resection of pancreatic cancer at Heidelberg University Hospital between 2009 and 2016. The entire patient cohort was sorted in ascending order based on mean intraoperative EtCO2 values and then divided into two groups: the high-EtCO2 group and the low-EtCO2 group. The pre-specified primary endpoint was the assessment of recurrence-free survival up to the last known follow-up. Cardiovascular events, surgical site infections, sepsis, and reoperations during the hospital stay, as well as overall survival were pre-specified secondary outcomes.ResultsMean EtCO2 was 33.8 mmHg ±1.1 in the low-EtCO2 group vs. 36.8 mmHg ±1.9 in the high-EtCO2 group. Median follow-up was 2.6 (Q1:1.4; Q3:4.4) years. Recurrence-free survival did not differ among the high and low-EtCO2 groups [HR = 1.043 (95% CI: 0.875–1.243), log rank test: p = 0.909]. Factors affecting the primary endpoint were studied via Cox analysis, which indicated no correlation between mean EtCO2 levels and recurrence-free survival [Coefficient −0.004, HR = 0.996 (95% CI:0.95–1.04); p = 0.871]. We did not identify any differences in the secondary endpoints, either.ConclusionsDuring elective pancreatic cancer surgery, anesthesiologists should set EtCO2 targets for reasons other than oncological outcome until conclusive evidence from prospective, multicenter randomized controlled trials is available.
期刊介绍:
Frontiers in Medicine publishes rigorously peer-reviewed research linking basic research to clinical practice and patient care, as well as translating scientific advances into new therapies and diagnostic tools. Led by an outstanding Editorial Board of international experts, this multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide.
In addition to papers that provide a link between basic research and clinical practice, a particular emphasis is given to studies that are directly relevant to patient care. In this spirit, the journal publishes the latest research results and medical knowledge that facilitate the translation of scientific advances into new therapies or diagnostic tools. The full listing of the Specialty Sections represented by Frontiers in Medicine is as listed below. As well as the established medical disciplines, Frontiers in Medicine is launching new sections that together will facilitate
- the use of patient-reported outcomes under real world conditions
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- addressing the grand health challenges around the world