British journal of anaesthesia
August 19, 2026 · via Europe PMC
Ketamine administration and postoperative mortality after major cancer surgery: a propensity-matched population-based study.
Talmy T, Ledot S, Cohen B, Eshel R, Charpak-Amikam Y, Clemer S, Avidan A, Nitzan I.
AI summary — for doctors, generated from the abstract only
In a large propensity-matched study of patients undergoing major cancer surgery, perioperative ketamine use was not associated with reduced 3-year or 5-year mortality, though it was associated with a lower likelihood of later markers suggestive of cancer progression, such as delayed initiation of chemotherapy or palliative care.
What was studied
A retrospective cohort study using the TriNetX US Collaborative Network, including adults undergoing major solid tumor cancer surgery between 2014 and 2023, comparing patients who received perioperative ketamine on the day of surgery versus those who did not (29,547 matched pairs after 1:1 propensity matching), with 3-year mortality as the primary outcome and 5-year mortality as a secondary outcome.
Key findings
- Among 176,149 eligible patients, perioperative ketamine was not associated with lower 3-year mortality (16.7% vs 16.0%; hazard ratio 1.04, 95% CI 1.00-1.09, q=0.187), and there was no difference in 5-year mortality.
- Across sensitivity and subgroup analyses by cancer type and perioperative exposures, ketamine was not associated with improved survival after adjustment for multiple comparisons.
- In an exploratory analysis, ketamine exposure was associated with a lower risk of a composite of surrogate markers suggestive of cancer progression (initiation of chemotherapy, radiotherapy, or palliative care 6 or more months after surgery) (HR 0.82, 95% CI 0.74-0.92, q=0.013).
Clinical relevance
This large study suggests that anesthesiologists should not expect perioperative ketamine use to improve long-term survival after major cancer surgery, consistent with prior studies of other anesthetic agents; the exploratory finding on cancer progression surrogates is interesting but should be treated as hypothesis-generating rather than a reason to use ketamine for oncologic benefit.
Who should care
Limitations
This is a retrospective, observational database study, so despite propensity matching, residual confounding cannot be excluded; the exploratory composite outcome of cancer progression surrogates was a secondary, hypothesis-generating analysis and should not be interpreted as established evidence of anti-cancer benefit.
Perioperative ketamine did not improve long-term survival after major cancer surgery in this large matched study, though it was linked to delayed markers of cancer progression as an exploratory finding.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Ketamine is commonly used perioperatively as an anaesthetic and analgesic adjunct and has demonstrated potential antitumour effects in preclinical studies. However, clinical and epidemiological data on its association with long-term outcomes after oncologic surgery remain limited.
Methods
We conducted a retrospective cohort study using the TriNetX US Collaborative Network, including adults (≥18 yr) undergoing major solid tumour cancer surgery between January 1, 2014, and April 1, 2023. The primary exposure was ketamine administration on the day of surgery. Propensity score matching (1:1) was performed using patient characteristics, comorbidities, oncologic diagnoses, and surgery type. The primary outcome was 3-yr mortality, and the secondary outcome was 5-yr mortality.
Results
Among 176 149 eligible patients, 29 547 matched pairs were analysed. Perioperative ketamine administration was not associated with lower 3-yr mortality (16.7% vs 16.0%; hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.00-1.09; q=0.187). There was no difference in 5-yr mortality. Across sensitivity and subgroup analyses by cancer type and perioperative exposures, ketamine was not associated with improved survival after adjustment for multiple comparisons. In an exploratory analysis, ketamine exposure was associated with a lower risk of a composite of surrogate markers suggestive of cancer progression or advanced disease, including initiation of chemotherapy, radiotherapy, or palliative care ≥6 months after surgery (HR, 0.82; 95% CI, 0.74-0.92; q=0.013).
Conclusions
In this research network study, perioperative ketamine use was not associated with reduced mortality after major cancer surgery. This finding aligns with previous large-scale studies showing no long-term survival benefit for specific anaesthetic agents in oncologic surgery.
DOI
10.1016/j.bja.2026.06.033
PMID
42618366
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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