Design: Systematic review and random-effects meta-analysis of randomised trials, trial sequential analysis
Population: 7,811 adults having curative cancer surgery in 11 trials
Primary outcome: Overall and recurrence-free survival
Effect: OS HR 1.05 (0.94-1.17); RFS HR 1.06 (0.95-1.19)

A systematic review and meta-analysis pooled 11 randomised trials in adults having curative cancer surgery: 3,904 given propofol-based and 3,907 volatile-based anaesthesia, with exploratory trial sequential analysis.

Overall survival (HR 1.05, 95% CI 0.94-1.17) and recurrence-free survival (HR 1.06, 0.95-1.19) did not differ. Mortality (RR 1.03, 0.94-1.13) and recurrence (RR 0.92, 0.76-1.12) were similar, with minimal heterogeneity. Trial sequential analysis judged the mortality finding robust but the recurrence finding inconclusive.

Observational studies had suggested that TIVA might protect against cancer recurrence, and some patients and surgeons request it for that reason. Randomised evidence now points strongly against a survival difference.

Choose the technique for its other merits: nausea, patient preference, airway, environmental impact and cost.

Do not choose TIVA solely to improve cancer outcomes.
Reassure patients who ask that either technique is safe for cancer surgery.
Use TIVA where it has other indications, such as high PONV risk.
Recurrence data remain inconclusive; ongoing trials may refine this.

Why it matters

It removes cancer survival as a reason to favour one anaesthetic technique over the other.

The statistics, in plain English

A hazard ratio of 1.05 with an interval from 0.94 to 1.17 rules out a meaningful survival benefit from propofol of more than about 6%. Trial sequential analysis checks whether enough patients have been studied; for mortality they have, for recurrence not yet.