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TOPLINE
Propofol-based and volatile-based anesthesia demonstrated comparable outcomes in patients undergoing curative cancer surgery, with no meaningful differences observed in overall survival, recurrence-free survival, mortality, and cancer recurrence.
METHODOLOGY
- Researchers conducted a systematic review and meta-analysis of 11 randomized controlled trials comparing propofol-based total intravenous anesthesia with volatile inhalational agents for maintenance anesthesia in adults undergoing curative or potentially curative cancer surgery.
- A total of 7811 patients were included, with 3904 allocated to the propofol-based anesthesia group and 3907 to the volatile-based anesthesia group, with baseline demographics being similar between groups.
- The primary outcomes assessed were overall survival and cancer recurrence; secondary outcomes were cancer-specific survival and time from anesthesia to recurrence.
- Recurrence-free survival served as a composite endpoint, defined as time from surgery to cancer recurrence or death, reflecting the prespecified primary outcomes of overall survival and cancer recurrence.
TAKEAWAY
- The meta-analysis found no significant difference in overall survival between propofol-based and volatile-based anesthesia groups (P = .42) or in recurrence-free survival (P = .31), with minimal heterogeneity (I2 = 0%) and high Grading of Recommendations Assessment, Development, and Evaluation certainty.
- Postoperative mortality was reported in 16.8% of patients receiving propofol-based anesthesia and 16.3% of patients receiving volatile-based anesthesia, showing no significant difference between groups.
- Cancer recurrence was observed in 12.2% of patients receiving propofol-based anesthesia and 13.2% patients receiving volatile-based anesthesia, with no significant difference noted.
IN PRACTICE
“Overall, this meta-analysis shows that propofol-based and volatile-based anesthesia yield equivalent long-term outcomes for cancer, including overall survival, recurrence-free survival, mortality, and recurrence,” the researchers reported.
SOURCE
The study was led by Ashmit Daiyan Mustafa, of the School of Medicine at Deakin University in Melbourne, Australia. It was published online on August 17, 2026, in Anaesthesia.
LIMITATIONS
Individual trials might have lacked sufficient statistical power to detect modest effects on rarer long-term events. Few studies looked at time-to-event outcomes, which might limit the robustness of those analyses. Data were sparse for subgroup analyses based on specific cancer sites and secondary outcomes, such as duration of anesthesia, making it hard to draw definitive conclusions.
DISCLOSURES
No external funding or competing interests were disclosed by the authors.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
