Association Between Anesthesia Delivered During Tumor Resection and Cancer Survival: a Systematic Review of a Mixed Picture with Constant Themes

Background Surgery is required for cure of most solid tumors, and general anesthesia is required for most cancer surgery. The vast majority of cancer surgery is facilitated by general anesthesia using volatile inhalational agents such as isoflurane and sevoflurane. Only recently have the immunologic and oncologic effect of inhalational agents, and their alternative, propofol-based total intravenous anesthesia (TIVA), come under investigation. Methods Between January 2019 and June 2020, English language articles on PubMed were searched for the keywords Propofol TIVA or IV anesthesia and either cancer surgery or surgical oncology. Duplicates were removes, manuscripts classified as either in vitro, animal, translational, or clinical studies, and their results summarized within these categories. Results In-vitro and translational data suggest that inhalational anesthetics are potent immunosuppressive and tumorigenic agents that promote metastasis, while propofol is anti-inflammatory, anti-tumorigenic, and prevents metastasis development. Clinically there is a recurring association, based largely on retrospective, single institution series, that TIVA is associated with significant improvements in disease-free interval and overall survival in a number of, but not all, solid tumors. The longer the surgery is, the more intense the surgical trauma is, the more aggressive the malignancy is, and the higher likelihood of an association is. Discussion Prospective randomized trials, coupled with basic science and translational studies, are needed to further define this association.

Automated summary

Searching English language articles on PubMed between January 2019 and June 2020 for the keywords Propofol TIVA, IV anesthesia, cancer surgery, and surgical oncology, revealed that in-vitro and translational data suggest inhalational anesthetics promote metastasis, while propofol prevents it. Some retrospective single institution clinical studies suggest that TIVA is associated with improved disease-free interval and overall survival in certain solid tumors. Further research through prospective randomized trials is needed to define this association.