- Design
- Systematic review and meta-analysis (3 randomised trials, 10 retrospective studies)
- Population
- 264,543 patients having curative oesophageal or gastric cancer surgery
- Primary outcome
- Overall survival, TIVA vs volatile anaesthesia
- Effect
- HR 0.80 (95% CI 0.69 to 0.93); gastrectomy HR 0.74 (0.60 to 0.91); oesophagectomy HR 0.89 (0.73 to 1.10)
A meta-analysis of 13 studies, 3 randomised and 10 retrospective, with 264,543 patients compared total intravenous anaesthesia (41,977 patients) with volatile anaesthesia (222,566) in curative oesophageal or gastric cancer surgery.
Pooling eight studies, overall survival was better with TIVA (HR 0.80, 95% CI 0.69 to 0.93). After gastrectomy the hazard ratio was 0.74 (0.60 to 0.91); after oesophagectomy it was 0.89 (0.73 to 1.10), which did not reach significance. Recurrence-free survival (HR 0.91, 0.77 to 1.06) and early mortality (HR 0.90, 0.77 to 1.05) showed non-significant trends. Operating time and hospital stay did not differ.
Because most data were retrospective, differences in who received TIVA, and when, may explain part of the signal. The authors call for prospective randomised studies. It is a reason to keep the question open, not to change an anaesthetic choice for cancer patients.
- Overall survival was better with TIVA in pooled data (HR 0.80), as an association.
- The signal was seen after gastrectomy but not after oesophagectomy.
- Recurrence-free survival did not differ significantly.
- Choose the anaesthetic on clinical grounds until prospective trials report.
Why it matters
It keeps a biologically plausible but unproven link between anaesthetic type and cancer outcome in view.
Don't overread it
Only 3 of 13 studies were randomised, and the oesophagectomy subgroup showed no significant difference.
The statistics, in plain English
A hazard ratio of 0.80 means about a fifth lower rate of death over follow-up in the TIVA groups. Retrospective groups differ in era, hospital and patient fitness, so the figure may partly reflect those differences rather than the drug.
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