Intravenous anaesthesia was associated with better survival after gastrectomy for cancer

Design

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

Population

264,543 adults undergoing curative oesophageal or gastric cancer surgery

Primary outcome

Overall survival

Effect

HR 0.80 (95% CI 0.69–0.93); gastrectomy HR 0.74 (0.60–0.91); oesophagectomy HR 0.89 (0.73–1.10)

This meta-analysis combined 13 studies, 3 randomised and 10 retrospective, with 264,543 patients undergoing curative surgery for oesophageal or gastric cancer, comparing total intravenous anaesthesia (TIVA) with volatile anaesthesia.

TIVA was associated with better overall survival (HR 0.80, 95% CI 0.69–0.93). The association was seen after gastrectomy (HR 0.74) but not after oesophagectomy (HR 0.89, 0.73–1.10). Recurrence-free survival and early mortality showed non-significant trends in the same direction. Operation time and length of stay did not differ.

The hypothesis — that propofol-based anaesthesia is less immunosuppressive than volatile agents — is plausible but unproven. The pooled result is dominated by large retrospective datasets in which the choice of anaesthetic was not random, and patients given TIVA may differ in ways not captured. Large randomised trials in other cancers have not shown a clear survival difference. It is not yet a reason to change anaesthetic practice.

• Do not change anaesthetic technique for cancer surgery on this evidence alone; it is mainly retrospective.
• The association was confined to gastrectomy; no difference was seen after oesophagectomy.
• Recurrence-free survival did not differ significantly.
• Discuss enrolment in randomised trials of anaesthetic technique where available.

Why it matters

It keeps alive a question — whether anaesthesia affects cancer outcomes — that only randomised trials can settle.

Don't overread it

Most data were retrospective; the association may reflect who received TIVA rather than the anaesthetic itself.

The statistics, in plain English

A hazard ratio of 0.80 means 20% lower risk of death at any time point in the TIVA group. But when most of the data come from non-randomised comparisons, even a narrow confidence interval only shows the association is consistent, not that it is causal.

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