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04.03.2019 | Review Article/Brief Review | Ausgabe 5/2019

Canadian Journal of Anesthesia/Journal canadien d'anesthésie 5/2019

Anesthetic technique and cancer outcomes: a meta-analysis of total intravenous versus volatile anesthesia

Canadian Journal of Anesthesia/Journal canadien d'anesthésie > Ausgabe 5/2019
FANZCA Andrea Yap, PhD Maria A. Lopez-Olivo, MBBS Julia Dubowitz, FANZCA Jonathan Hiller, PhD Bernhard Riedel, the Global Onco-Anesthesia Research Collaboration Group
Wichtige Hinweise
This article is accompanied by an editorial. Please see Can J Anesth 2019; 66: this issue.
A correction to this article is available online at https://​doi.​org/​10.​1007/​s12630-019-01381-0.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.



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.


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).


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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