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 Sawdagar
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In 30 seconds
This systematic review and meta-analysis assessed randomised trials comparing propofol-based with volatile-based anaesthesia in adults undergoing curative cancer surgery. Eleven studies included 3904 patients assigned to propofol and 3907 to volatile anaesthesia. There was no significant difference in overall survival (hazard ratio 1.05, 95%CI 0.94-1.17, p = 0.42) or recurrence-free survival (hazard ratio 1.06, 95%CI 0.95-1.19, p = 0.31). Mortality and recurrence also did not differ significantly. The authors report high-certainty evidence overall, while noting that recurrence findings remain inconclusive.
Key findings
- Overall survival did not differ significantly between groups: hazard ratio 1.05 (95%CI 0.94-1.17, p = 0.42).
- Recurrence-free survival did not differ significantly: hazard ratio 1.06 (95%CI 0.95-1.19, p = 0.31).
- Mortality was similar (relative risk 1.03, 95%CI 0.94-1.13, p = 0.48), as was recurrence (relative risk 0.92, 95%CI 0.76-1.12, p = 0.41).
- The review included 11 randomised trials, with 3904 patients assigned to propofol-based and 3907 to volatile-based anaesthesia.
Why it matters
The findings address concern that anaesthetic choice during curative cancer surgery might alter long-term oncological outcomes. Across the included randomised trials, neither approach showed a significant advantage for survival or recurrence outcomes. This helps frame anaesthetic selection without assuming that one technique improves cancer prognosis, while the remaining uncertainty around recurrence warrants appropriate caution.
What to keep in mind
The authors state that recurrence findings remain inconclusive, despite minimal detected heterogeneity across analyses.