{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T15:00:25Z","timestamp":1774969225211,"version":"3.50.1"},"reference-count":40,"publisher":"BMJ","issue":"11","funder":[{"DOI":"10.13039\/100007452","name":"Wu Jieping Medical Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007452","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Chinese Society of Cardiothoracic and Vascular Anesthesiology"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2017,9,4]]},"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Elderly patients who have solid organ cancer often receive surgery. Some of them may develop delirium after surgery and delirium development is associated with worse outcomes. Furthermore, despite all of the advances in medical care, the long-term survival in cancer patients is far from optimal. Evidences suggest that choice of anaesthetics during surgery, that is, either inhalational or intravenous anaesthetics, may influence outcomes. However, the impact of general anaesthesia type on the occurrence of postoperative delirium is inconclusive. Although retrospective studies suggest that propofol-based intravenous anaesthesia was associated with longer survival after cancer surgery when compared with inhalational anaesthesia, prospective studies as such are still lacking. The purposes of this randomised controlled trial are to test the hypotheses that when compared with sevoflurane-based inhalational anaesthesia, propofol-based intravenous anaesthesia may reduce the incidence of early delirium and prolong long-term survival in elderly patients after major cancer surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This is a multicentre, open-label, randomised controlled trial with two parallel arms. 1200 elderly patients (\u226565 years but &lt;90 years) who are scheduled to undergo major cancer surgery (with predicted duration \u22652\u2009hours) are randomised to receive either sevoflurane-based inhalational anaesthesia or propofol-based intravenous anaesthesia. Other anaesthetics and supplemental drugs including sedatives, opioids and muscle relaxants are administered in both arms according to routine practice. The primary early outcome is the incidence of 7-day delirium after surgery and the primary long-term outcome is the duration of 3-year survival after surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study protocol has been approved by the Clinical Research Ethics Committees of Peking University First Hospital (2015[869]) and all participating centres. The results of early and long-term outcomes will be analysed and reported separately.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      ChiCTR-IPR-15006209;\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT02662257\">NCT02662257<\/jats:ext-link>\n                      ;\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT02660411\">NCT02660411<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-018607","type":"journal-article","created":{"date-parts":[[2017,11,29]],"date-time":"2017-11-29T01:40:24Z","timestamp":1511919624000},"page":"e018607","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":20,"title":["Impact of inhalational versus intravenous anaesthesia on early delirium and long-term survival in elderly patients after cancer surgery: study protocol of a multicentre, open-label, and randomised controlled trial"],"prefix":"10.1136","volume":"7","clinical-trial-number":[{"clinical-trial-number":"nct02662257","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct02660411","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct00418457","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct02662257","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct02660411","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Yue","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui-Juan","family":"Li","sequence":"additional","affiliation":[{"name":"Project Development and Project Management Department, Peking University Clinical Research Institute, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3205-1836","authenticated-orcid":false,"given":"Dong-Xin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui-Qun","family":"Jia","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xu-De","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Tang-Du Hospital Fourth Military Medical University, Xi\u2019an, Shaanxi, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ling-Hui","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qing-Shan","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Ningxia People\u2019s Hospital, Yinchuan, Ningxia Hui Autonomous Region, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen","family":"Ouyang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Third Xiangya Hospital Central South University, Changsha, Hunan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhen","family":"Jia","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Qinghai University Affiliated Hospital, Xining, Qinghai, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fang-Xiang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Guizhou Provincial People\u2019s Hospital, Guiyang, Guizhou, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong-Qing","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shanxi Provincial People\u2019s Hospital, Taiyuan, Shanxi, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan-Qiu","family":"Ai","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bin-Jiang","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Beijing Shijitan Hospital, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xu-Dong","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Peking University Hospital of Stomatology, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qin-Gong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shanxi Provincial Cancer Hospital, Taiyuan, Shanxi, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ning","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Southeast University Zhongda Hospital, Nanjing, Jiangsu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong-Yu","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Peking University Cancer Hospital&Institute, Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education), Beijing, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhi-Heng","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shenzhen Second People\u2019s Hospital, Shenzhen, Guangzhou, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jian-Bo","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Tianjin Nankai Hospital, Tianjin, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daqing","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer, Anaesthetics, Pain Medicine and Intensive Care Section, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,11,28]]},"reference":[{"key":"2025121513423326000_7.11.e018607.1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21338"},{"key":"2025121513423326000_7.11.e018607.2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21262"},{"key":"2025121513423326000_7.11.e018607.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60878-8"},{"key":"2025121513423326000_7.11.e018607.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60160-X"},{"key":"2025121513423326000_7.11.e018607.5","unstructured":"Diagnostic and statistical manual of mental disorders. Fifth edn. Arlington, VA: American Psychiatric Association, 2013."},{"key":"2025121513423326000_7.11.e018607.6","doi-asserted-by":"crossref","first-page":"e21","DOI":"10.1002\/bjs.10062","article-title":"Systematic review and meta-analysis of risk factors for postoperative delirium among older patients undergoing gastrointestinal surgery","volume":"103","author":"Scholz","year":"2016","journal-title":"Br J Surg"},{"key":"2025121513423326000_7.11.e018607.7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ijsu.2016.09.001","article-title":"Risk factors of post-operative delirium after elective vascular surgery in the elderly: A systematic review","volume":"35","author":"Raats","year":"2016","journal-title":"Int J Surg"},{"key":"2025121513423326000_7.11.e018607.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2015.03.012"},{"key":"2025121513423326000_7.11.e018607.9","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e31819ffe38"},{"key":"2025121513423326000_7.11.e018607.10","first-page":"S301","article-title":"Postoperative delirium and functional decline after noncardiac surgery","volume":"59 Suppl 2","author":"Quinlan","year":"2011","journal-title":"J Am Geriatr Soc"},{"key":"2025121513423326000_7.11.e018607.11","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/289185"},{"key":"2025121513423326000_7.11.e018607.12","doi-asserted-by":"publisher","DOI":"10.1186\/cc13084"},{"key":"2025121513423326000_7.11.e018607.13","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200904-0537OC"},{"key":"2025121513423326000_7.11.e018607.14","doi-asserted-by":"publisher","DOI":"10.1159\/000140804"},{"key":"2025121513423326000_7.11.e018607.15","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2702.2009.02933.x"},{"key":"2025121513423326000_7.11.e018607.16","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-006-0399-8"},{"key":"2025121513423326000_7.11.e018607.17","doi-asserted-by":"publisher","DOI":"10.1097\/DCC.0b013e31822fa97c"},{"key":"2025121513423326000_7.11.e018607.18","first-page":"CD005563","article-title":"Interventions for preventing delirium in hospitalised non-ICU patients","volume":"3","author":"Siddiqi","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121513423326000_7.11.e018607.19","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1097\/ALN.0b013e31823da7a2","article-title":"Association between the apolipoprotein E4 and postoperative cognitive dysfunction in elderly patients undergoing intravenous anesthesia and inhalation anesthesia","volume":"116","author":"Cai","year":"2012","journal-title":"Anesthesiology"},{"key":"2025121513423326000_7.11.e018607.20","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2012.12.009"},{"key":"2025121513423326000_7.11.e018607.21","doi-asserted-by":"publisher","DOI":"10.1177\/0300060514549781"},{"key":"2025121513423326000_7.11.e018607.22","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1111\/j.0001-5172.2004.00264.x","article-title":"Recovery characteristics and post-operative delirium after long-duration laparoscope-assisted surgery in elderly patients: propofol-based vs. sevoflurane-based anesthesia","volume":"48","author":"Nishikawa","year":"2004","journal-title":"Acta Anaesthesiol Scand"},{"key":"2025121513423326000_7.11.e018607.23","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aer091"},{"key":"2025121513423326000_7.11.e018607.24","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0b013e3181ef4d05"},{"key":"2025121513423326000_7.11.e018607.25","doi-asserted-by":"crossref","first-page":"i56","DOI":"10.1093\/bja\/aeu200","article-title":"Effect of anaesthetic technique on the natural killer cell anti-tumour activity of serum from women undergoing breast cancer surgery: a pilot study","volume":"113 Suppl 1","author":"Buckley","year":"2014","journal-title":"Br J Anaesth"},{"key":"2025121513423326000_7.11.e018607.26","first-page":"1311","article-title":"Effect of anaesthetic technique on immune cell infiltration in breast cancer: a follow-up pilot analysis of a prospective, randomised, investigator-masked study","volume":"35","author":"Desmond","year":"2015","journal-title":"Anticancer Res"},{"key":"2025121513423326000_7.11.e018607.27","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1111\/j.1365-2044.2010.06304.x","article-title":"Differential effects of propofol and isoflurane on the activation of T-helper cells in lung cancer patients","volume":"65","author":"Ren","year":"2010","journal-title":"Anaesthesia"},{"key":"2025121513423326000_7.11.e018607.28","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1177\/0310057X1404200209","article-title":"Effects of different general anaesthetic techniques on immune responses in patients undergoing surgery for tongue cancer","volume":"42","author":"Zhang","year":"2014","journal-title":"Anaesth Intensive Care"},{"key":"2025121513423326000_7.11.e018607.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopha.2010.03.006"},{"key":"2025121513423326000_7.11.e018607.30","first-page":"1722","article-title":"Propofol inhibits invasion and enhances paclitaxel- induced apoptosis in ovarian cancer cells through the suppression of the transcription factor slug","volume":"17","author":"Wang","year":"2013","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"2025121513423326000_7.11.e018607.31","first-page":"1321","article-title":"Propofol and bupivacaine in breast cancer cell function in vitro - role of the NET1 gene","volume":"34","author":"Ecimovic","year":"2014","journal-title":"Anticancer Res"},{"key":"2025121513423326000_7.11.e018607.32","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2014.426"},{"key":"2025121513423326000_7.11.e018607.33","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e31829e47fd"},{"key":"2025121513423326000_7.11.e018607.34","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1007\/s00540-011-1317-y","article-title":"Sevoflurane inhibits invasion and migration of lung cancer cells by inactivating the p38 MAPK signaling pathway","volume":"26","author":"Liang","year":"2012","journal-title":"J Anesth"},{"key":"2025121513423326000_7.11.e018607.35","doi-asserted-by":"crossref","first-page":"197","DOI":"10.3892\/mmr.2013.1806","article-title":"The common anesthetic, sevoflurane, induces apoptosis in A549 lung alveolar epithelial cells","volume":"9","author":"Wei","year":"2014","journal-title":"Mol Med Rep"},{"key":"2025121513423326000_7.11.e018607.36","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1007\/s00540-015-2035-7","article-title":"Sevoflurane suppresses hypoxia-induced growth and metastasis of lung cancer cells via inhibiting hypoxia-inducible factor-1\u03b1","volume":"29","author":"Liang","year":"2015","journal-title":"J Anesth"},{"key":"2025121513423326000_7.11.e018607.37","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e3182605df1"},{"key":"2025121513423326000_7.11.e018607.38","doi-asserted-by":"publisher","DOI":"10.3109\/03009734.2014.922649"},{"key":"2025121513423326000_7.11.e018607.39","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000000936"},{"key":"2025121513423326000_7.11.e018607.40","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e7586"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2017-018607","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T21:42:42Z","timestamp":1765834962000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2017-018607"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11]]},"references-count":40,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2017,11,28]]},"published-print":{"date-parts":[[2017,11]]}},"alternative-id":["10.1136\/bmjopen-2017-018607"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2017-018607","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,11]]}}}