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.
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
Study at a glance
- Design
- RCT — 1:1 propofol vs sevoflurane for anaesthesia maintenance in curative primary breast cancer surgery
- N
- N=1670 · ITT: 841 propofol, 829 sevoflurane
- Population
- Patients undergoing curative primary breast cancer surgery
- Outcome
- 5-year overall survival
Structured fields used in claim comparison tables when every cited study has a complete layer.
What they did
Investigators randomly allocated patients having curative primary breast cancer surgery to propofol or sevoflurane for anaesthesia maintenance in a 1:1 ratio. The primary endpoint was 5-year overall survival in intention-to-treat and per-protocol analyses.
What they found
Among 1670 patients analysed by intention to treat (841 propofol, 829 sevoflurane), five-year survival was about 92% in both arms, with a hazard ratio near 1 and no statistically significant difference. Results were similar after per-protocol analysis and adjustment for uneven triple-negative receptor status.
The limits
What it doesn't show
Equivalence for rare mortality outcomes is hard to prove even in a large trial, and opioid co-analgesia differed by arm. Findings apply to primary breast cancer surgery, not all cancer types, and further trials are still needed for guideline change.
Key terms
- Propofol
- Intravenous anaesthetic used for induction and, in one trial arm, maintenance.
- Sevoflurane
- Volatile anaesthetic used for maintenance after propofol induction in the comparator arm.
- Intention-to-treat (ITT)
- Analysis including participants in their assigned groups regardless of later protocol deviations.
- Per-protocol (PP)
- Analysis restricted to patients who received the intended anaesthetic without crossover.
- Overall survival
- Time from surgery until death from any cause.
- Hazard ratio (HR)
- Relative instantaneous risk of death between anaesthetic groups over follow-up.
Flashcards
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Quiz yourself
What was CAN’s primary endpoint?
Common questions
What was the primary outcome?
Five-year overall survival after breast cancer surgery.
Did propofol improve survival?
No meaningful difference versus sevoflurane was found.
How many patients were in the ITT analysis?
1670 patients remained for ITT (841 propofol, 829 sevoflurane).
Were the groups perfectly matched?
Mostly comparable, with some differences in triple-negative status and opioid use.
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