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Background:  Choice of the fraction of inspiratory oxygen (FiO 2 ) is controversial. The objective of this analysis was to evaluate whether intraoperative FiO 2  was associated with recurrence-free survival after elective cancer surgery.   Methods and Analysis:  In this single-center, retrospective study, we analyzed 1,084 patients undergoing elective resection of pancreatic ( n  = 652), colorectal ( n  = 405), or hepatic cancer ( n  = 27) at Heidelberg University Hospital between 2009 and 2016. Intraoperative mean FiO 2  values were calculated. For unstratified analyses, the study cohort was equally divided into a low- and a high-FiO 2  group. For cancer-stratified analyses, this division was done within cancer-strata. The primary outcome measure was recurrence-free survival until the last known follow-up. Groups were compared using Kaplan–Meier analysis. A stratified log rank test was used to control for different FiO 2  levels and survival times between the cancer strata. Cox-regression analyses were used to control for covariates. Sepsis, reoperations, surgical-site infections, and cardiovascular events during hospital stay and overall survival were secondary outcomes.   Results:  Median FiO 2  was 40.9% (Q1–Q3, 38.3–42.9) in the low vs. 50.4% (Q1–Q3, 47.4–54.7) in the high-FiO 2  group. Median follow-up was 3.28 (Q1–Q3, 1.68–4.97) years. Recurrence-free survival was considerable higher in the high-FiO 2  group ( p  &amp;lt; 0.001). This effect was also confirmed when stratified for the different tumor entities ( p  = 0.007). In colorectal cancer surgery, increased FiO 2  was independently associated with increased recurrence-free survival. The hazard for the primary outcome decreased by 3.5% with every 1% increase in FiO 2 . The effect was not seen in pancreatic cancer surgery and we did not find differences in any of the secondary endpoints.   Conclusions:  Until definite evidence from large-scale trials is available and in the absence of relevant clinical conditions warranting specific FiO 2  values, perioperative care givers should aim for an intraoperative FiO 2  of 50% in abdominal cancer surgery as this might benefit oncological outcomes.

Intraoperative Fractions of Inspiratory Oxygen Are Associated With Recurrence-Free Survival After Elective Cancer Surgery