Abstract
BACKGROUND: Gastric cancer is a major global health issue, and the perioperative period critically influences patient outcomes. The different effects of sevoflurane inhalation anesthesia and propofol total intravenous anesthesia on intraoperative stability, postoperative complications, and long-term oncologic outcomes in patients with gastric cancer undergoing radical gastrectomy remain unclear. AIM: To compare the effects of sevoflurane inhalation anesthesia and propofol total intravenous anesthesia on clinical outcomes, including intraoperative indicators, postoperative complications, adverse effects, pain scores, and survival. METHODS: This single-center retrospective cohort study included 204 patients who underwent radical gastrectomy for gastric cancer from February 2019 to December 2022. Patients were assigned to either the sevoflurane group (n = 103) or the propofol group (n = 101) based on intraoperative anesthetic regimen. Standardized protocols for anesthesia management, intraoperative monitoring, and postoperative analgesia were applied. Baseline characteristics; intraoperative metrics; adverse events; complications; Visual Analog Scale (VAS) scores at 2, 4, 6, 24, and 48 hours; and survival outcomes were retrospectively collected. Group comparisons were performed using χ (2) for categorical variables, t test for continuous variables, and Kaplan-Meier analysis for survival outcomes. RESULTS: Baseline demographic and clinical characteristics were similar between groups. No significant differences were observed in intraoperative indicators or most 30-day postoperative outcomes, including length of stay, emergency department visits, and readmission rates. The propofol group showed elevated mean VAS pain score at 24 hours postoperatively, but no differences were found at other time points. The propofol group also had significantly higher postoperative nausea incidence and transiently higher systolic/diastolic blood pressure and heart rate at the time of incision than the sevoflurane group. No significant differences were seen in overall rates or severity of postoperative complications, intraoperative adverse events, or in overall survival and progression-free survival. CONCLUSION: In patients undergoing radical gastrectomy for gastric cancer, sevoflurane and propofol anesthesia demonstrated similar profiles regarding intraoperative safety, postoperative complications, adverse events, postoperative pain, and long-term survival. The selection of anesthesia can be personalized without significantly affecting perioperative or oncologic outcomes.