Long-term prognosis after cancer surgery with inhalational anesthesia and total intravenous anesthesia: a systematic review and meta-analysis

Background: A number of teams have investigated the association between the mode of anesthesia and the long-term outcomes after cancer surgeries, with inconsistent conclusions. We conducted this systematic review and meta-analysis to summarize the currently available findings of clinical studies on the long-term outcomes after cancer surgery under inhalational anesthesia with volatile anesthetics (VA) and total intravenous anesthesia (TIVA) with propofol.

Methods: We systematically searched PubMed, Central, EMBASE, CINAHL, Google Scholar, Web of Science citation index, US clinical trials register, UK clinical trials register, Australia and New Zealand Clinical trials register for clinical studies comparing postoperative outcomes of VA and TIVA. The included outcomes were all-cause mortality, recurrence and recurrence free survival. Meta-analysis was done using the generic inverse variance method.

Results: The overall pooled hazard ratio for all-cause mortality was in favor of TIVA [Harzard ratio (HR) 0.73, 95% confidence interval (CI) 0.60 to 0.89], so was the recurrence free survival (HR 1.22, 95% CI 1.07 to 1.41). The subgroup analysis of mortality in different cancer types did not show any remarkable difference between the intravenous or volatile anesthesia. There was also no significant difference in recurrence.

Conclusion: Our meta-analysis suggests that TIVA is associated with lower all-cause mortality after cancer surgeries. As cancers of different origins can respond very differently to pharmacological intervention, more clinical trials are needed in each cancer types in order to substantiate the role of anesthesia in cancer surgery prognosis.