Impact of propofol‐based vs. volatile‐based anaesthesia on survival and recurrence after cancer surgery: a systematic review and meta‐analysis of randomised trials
Ashmit Daiyan Mustafa, Pavan Shet, Sameen Shadman SawdagarSummary
Introduction
Choice of peri‐operative anaesthetic technique may influence cancer recurrence, survival and mortality following curative surgery. Conflicting evidence exists on whether propofol‐based anaesthesia improves outcomes over volatile anaesthesia. This systematic review and meta‐analysis examined evidence from randomised trials on overall survival and recurrence in adult patients having oncological surgery.
Methods
We systematically searched relevant databases for randomised trials comparing propofol‐based with volatile‐based anaesthesia in adults undergoing curative cancer surgery. In addition to narrative synthesis, random‐effects meta‐analysis was performed with exploratory trial sequential analysis.
Results
Eleven studies were included, comprising 3904 and 3907 patients assigned to propofol‐based or volatile‐based anaesthesia, respectively. Meta‐analysis found no significant effect on overall or recurrence‐free survival with a hazard ratio of 1.05 (95%CI 0.94–1.17, p = 0.42) and 1.06 (95%CI 0.95–1.19, p = 0.31), respectively. There was no significant effect on mortality (relative risk 1.03, 95%CI 0.94–1.13, p = 0.48). Similar results were found for recurrence (relative risk 0.92, 95%CI 0.76–1.12, p = 0.41). There was minimal detected heterogeneity in all analyses.
Discussion
Propofol‐based and volatile‐based anaesthesia yield similar long‐term oncological outcomes, with no significant differences in survival or recurrence and minimal heterogeneity, supported by high‐certainty evidence. Trial sequential analysis confirms mortality findings are robust while recurrence remains inconclusive.