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ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 11 - 2024 |
doi: 10.3389/fmed.2024.1442283
This article is part of the Research Topic The Anesthesiologist as an Avatar: Bending Air to Preserve Life View all articles
Intraoperative end-tidal carbon dioxide levels are not associated with recurrence-free survival after elective pancreatic cancer surgery: a retrospective cohort study
Provisionally accepted- Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
Background: Intraoperative 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. Methods: In 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. Results: Mean EtCO2 was 33.8mmHg ±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 -.004, HR=0.996 (95% CI:0.95-1.04); p= .871]. We did not identify any differences in the secondary endpoints, either. Conclusions: During 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.
Keywords: Carbon Dioxide, Pancreatic cancer surgery, Oncological outcome, Recurrence-free survival, perioperative complications
Received: 01 Jun 2024; Accepted: 13 Aug 2024.
Copyright: © 2024 Dehne, Kirschner, Klotz, Kilian, Michalski, Hackert, Büchler, Weigand and Larmann. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Jan Larmann, Heidelberg University Hospital, Heidelberg, 69120, Baden-Württemberg, Germany
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Lina Kirschner