TIVA was associated with better survival after gastrectomy for cancer, mainly in retrospective data

Design

Systematic review and meta-analysis (3 RCTs, 10 retrospective studies)

Population

264,543 patients having curative oesophagogastric cancer surgery

Primary outcome

Overall survival, TIVA vs volatile anaesthesia

Effect

HR 0.80 (0.69–0.93); gastrectomy HR 0.74; oesophagectomy HR 0.89 (NS)

A meta-analysis in Langenbeck's Archives of Surgery pooled 13 studies — 3 randomised trials and 10 retrospective cohorts, 264,543 patients — comparing total intravenous anaesthesia (TIVA) with volatile anaesthesia for curative oesophageal or gastric cancer surgery.

TIVA was associated with better overall survival (HR 0.80). The association was significant for gastrectomy (HR 0.74) but not oesophagectomy (HR 0.89). Recurrence-free survival and early mortality trended in favour of TIVA without reaching significance. Operating time and length of stay did not differ.

Laboratory data suggest propofol may preserve anti-tumour immunity better than volatile agents. Retrospective studies are prone to confounding, however: patients and centres that use TIVA may differ in other ways. Randomised evidence on this question remains limited and inconclusive.

For gastroenterologists and surgeons, this is a question to watch, not yet a reason to specify the anaesthetic.

• Treat the survival association with TIVA as hypothesis-generating; most data are retrospective
• Leave the choice of anaesthetic technique to the anaesthetic team on current evidence
• Note the signal was confined to gastrectomy, not oesophagectomy

Why it matters

It keeps alive the question of whether anaesthetic choice affects cancer outcomes.

Don't overread it

Mostly retrospective studies: the survival difference may reflect who received TIVA, not the drug.

The statistics, in plain English

An HR of 0.80 means a 20% lower death rate, but with only three randomised trials, residual confounding from the retrospective studies is likely.

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