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

Andrea Yap, Maria A. Lopez-Olivo, Julia Dubowitz, Jonathan Hiller, Bernhard Riedel, the Global Onco-Anesthesia Research Collaboration Group

Research output: Contribution to journalReview ArticleResearchpeer-review

Abstract

Canadian Anesthesiologists' Society. Purpose: 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. Source: 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). Conclusion: 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.
Original languageEnglish
Pages (from-to)546-561
Number of pages16
JournalCanadian Journal of Anesthesia
Volume66
Issue number5
DOIs
Publication statusPublished - 15 May 2019

Cite this

Yap, A., Lopez-Olivo, M. A., Dubowitz, J., Hiller, J., Riedel, B., & the Global Onco-Anesthesia Research Collaboration Group (2019). Anesthetic technique and cancer outcomes: a meta-analysis of total intravenous versus volatile anesthesia. Canadian Journal of Anesthesia, 66(5), 546-561. https://doi.org/10.1007/s12630-019-01330-x
Yap, Andrea ; Lopez-Olivo, Maria A. ; Dubowitz, Julia ; Hiller, Jonathan ; Riedel, Bernhard ; the Global Onco-Anesthesia Research Collaboration Group. / Anesthetic technique and cancer outcomes: a meta-analysis of total intravenous versus volatile anesthesia. In: Canadian Journal of Anesthesia. 2019 ; Vol. 66, No. 5. pp. 546-561.
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abstract = "Canadian Anesthesiologists' Society. Purpose: 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. Source: 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). Conclusion: 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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Yap, A, Lopez-Olivo, MA, Dubowitz, J, Hiller, J, Riedel, B & the Global Onco-Anesthesia Research Collaboration Group 2019, 'Anesthetic technique and cancer outcomes: a meta-analysis of total intravenous versus volatile anesthesia' Canadian Journal of Anesthesia, vol. 66, no. 5, pp. 546-561. https://doi.org/10.1007/s12630-019-01330-x

Anesthetic technique and cancer outcomes: a meta-analysis of total intravenous versus volatile anesthesia. / Yap, Andrea; Lopez-Olivo, Maria A.; Dubowitz, Julia; Hiller, Jonathan; Riedel, Bernhard; the Global Onco-Anesthesia Research Collaboration Group.

In: Canadian Journal of Anesthesia, Vol. 66, No. 5, 15.05.2019, p. 546-561.

Research output: Contribution to journalReview ArticleResearchpeer-review

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T1 - Anesthetic technique and cancer outcomes: a meta-analysis of total intravenous versus volatile anesthesia

AU - Yap, Andrea

AU - Lopez-Olivo, Maria A.

AU - Dubowitz, Julia

AU - Hiller, Jonathan

AU - Riedel, Bernhard

AU - the Global Onco-Anesthesia Research Collaboration Group

AU - Sloan, Erica

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N2 - Canadian Anesthesiologists' Society. Purpose: 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. Source: 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). Conclusion: 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.

AB - Canadian Anesthesiologists' Society. Purpose: 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. Source: 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). Conclusion: 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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Yap A, Lopez-Olivo MA, Dubowitz J, Hiller J, Riedel B, the Global Onco-Anesthesia Research Collaboration Group. Anesthetic technique and cancer outcomes: a meta-analysis of total intravenous versus volatile anesthesia. Canadian Journal of Anesthesia. 2019 May 15;66(5):546-561. https://doi.org/10.1007/s12630-019-01330-x