TY - JOUR
T1 - Anesthetic technique and cancer outcomes
T2 - a meta-analysis of total intravenous versus volatile anesthesia
AU - the Global Onco-Anesthesia Research Collaboration Group
AU - Yap, Andrea
AU - Lopez-Olivo, Maria A.
AU - Dubowitz, Julia
AU - Hiller, Jonathan
AU - Riedel, Bernhard
AU - Wigmore, Timothy
AU - Ferguson, Marissa
AU - Shan, David
AU - Yee, Ken
AU - Meyer, Ilonka
AU - Schier, Robert
AU - Gottumukkala, Vijaya
AU - Wilks, Jonathan
AU - Schick, Volker
AU - Hui, Victor
AU - Sloan, Erica
AU - Cata, Juan
AU - Buggy, Donal
N1 - Publisher Copyright:
© 2019, Canadian Anesthesiologists' Society.
PY - 2019/5/15
Y1 - 2019/5/15
N2 - Purpose: Cancer-related mortality, a leading cause of death worldwide, is often the result of metastatic disease recurrence. Anesthetic techniques have varying effects on innate and cellular immunity, activation of adrenergic-inflammatory pathways, and activation of cancer-promoting cellular signaling pathways; these effects may translate into an influence of anesthetic technique on long-term cancer outcomes. To further analyze the effects of propofol (intravenous) and volatile (inhalational gas) anesthesia on cancer recurrence and survival, we undertook a systematic review with meta-analysis. Source: Databases were searched up to 14 November 2018. Comparative studies examining the effect of inhalational volatile anesthesia and propofol-based total intravenous anesthesia (TIVA) on cancer outcomes were included. The Newcastle Ottawa Scale (NOS) was used to assess methodological quality and bias. Reported hazard ratios (HRs) were pooled and 95% confidence intervals (CIs) calculated. Principal findings: Ten studies were included; six studies examined the effect of anesthetic agent type on recurrence-free survival following breast, esophageal, and non-small cell lung cancer (n = 7,866). The use of TIVA was associated with improved recurrence-free survival in all cancer types (pooled HR, 0.78; 95% CI, 0.65 to 0.94; P < 0.01). Eight studies (n = 18,778) explored the effect of anesthetic agent type on overall survival, with TIVA use associated with improved overall survival (pooled HR, 0.76; 95% CI, 0.63 to 0.92; P < 0.01). Conclusion: This meta-analysis suggests that propofol-TIVA use may be associated with improved recurrence-free survival and overall survival in patients having cancer surgery. This is especially evident where major cancer surgery was undertaken. Nevertheless, given the inherent limitations of studies included in this meta-analysis these findings necessitate prospective randomized trials to guide clinical practice. Trial registration: PROSPERO (CRD42018081478); registered 8 October, 2018.
AB - Purpose: Cancer-related mortality, a leading cause of death worldwide, is often the result of metastatic disease recurrence. Anesthetic techniques have varying effects on innate and cellular immunity, activation of adrenergic-inflammatory pathways, and activation of cancer-promoting cellular signaling pathways; these effects may translate into an influence of anesthetic technique on long-term cancer outcomes. To further analyze the effects of propofol (intravenous) and volatile (inhalational gas) anesthesia on cancer recurrence and survival, we undertook a systematic review with meta-analysis. Source: Databases were searched up to 14 November 2018. Comparative studies examining the effect of inhalational volatile anesthesia and propofol-based total intravenous anesthesia (TIVA) on cancer outcomes were included. The Newcastle Ottawa Scale (NOS) was used to assess methodological quality and bias. Reported hazard ratios (HRs) were pooled and 95% confidence intervals (CIs) calculated. Principal findings: Ten studies were included; six studies examined the effect of anesthetic agent type on recurrence-free survival following breast, esophageal, and non-small cell lung cancer (n = 7,866). The use of TIVA was associated with improved recurrence-free survival in all cancer types (pooled HR, 0.78; 95% CI, 0.65 to 0.94; P < 0.01). Eight studies (n = 18,778) explored the effect of anesthetic agent type on overall survival, with TIVA use associated with improved overall survival (pooled HR, 0.76; 95% CI, 0.63 to 0.92; P < 0.01). Conclusion: This meta-analysis suggests that propofol-TIVA use may be associated with improved recurrence-free survival and overall survival in patients having cancer surgery. This is especially evident where major cancer surgery was undertaken. Nevertheless, given the inherent limitations of studies included in this meta-analysis these findings necessitate prospective randomized trials to guide clinical practice. Trial registration: PROSPERO (CRD42018081478); registered 8 October, 2018.
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U2 - 10.1007/s12630-019-01330-x
DO - 10.1007/s12630-019-01330-x
M3 - Review article
C2 - 30834506
AN - SCOPUS:85062153041
SN - 0832-610X
VL - 66
SP - 546
EP - 561
JO - Canadian Journal of Anesthesia
JF - Canadian Journal of Anesthesia
IS - 5
ER -