Andrea Yap1,2, Maria A Lopez-Olivo3, Julia Dubowitz4,5, Jonathan Hiller4,5,6, Bernhard Riedel4,5,6. 1. Department of Anaesthesia, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore. andrea_yap@nuhs.edu.sg. 2. Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia. andrea_yap@nuhs.edu.sg. 3. Department of General Internal Medicine, Section of Rheumatology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA. 4. Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia. 5. Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, Australia. 6. Anaesthesia, Pain and Perioperative Medicine Unit & The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
Abstract
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.
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.
Authors: Jonathan G Hiller; Nicholas J Perry; George Poulogiannis; Bernhard Riedel; Erica K Sloan Journal: Nat Rev Clin Oncol Date: 2017-12-28 Impact factor: 66.675
Authors: Richard Sullivan; Olusegun Isaac Alatise; Benjamin O Anderson; Riccardo Audisio; Philippe Autier; Ajay Aggarwal; Charles Balch; Murray F Brennan; Anna Dare; Anil D'Cruz; Alexander M M Eggermont; Kenneth Fleming; Serigne Magueye Gueye; Lars Hagander; Cristian A Herrera; Hampus Holmer; André M Ilbawi; Anton Jarnheimer; Jia-Fu Ji; T Peter Kingham; Jonathan Liberman; Andrew J M Leather; John G Meara; Swagoto Mukhopadhyay; Shilpa S Murthy; Sherif Omar; Groesbeck P Parham; C S Pramesh; Robert Riviello; Danielle Rodin; Luiz Santini; Shailesh V Shrikhande; Mark Shrime; Robert Thomas; Audrey T Tsunoda; Cornelis van de Velde; Umberto Veronesi; Dehannathparambil Kottarathil Vijaykumar; David Watters; Shan Wang; Yi-Long Wu; Moez Zeiton; Arnie Purushotham Journal: Lancet Oncol Date: 2015-09 Impact factor: 41.316
Authors: Mats Enlund; Anders Berglund; Kalle Andreasson; Catharina Cicek; Anna Enlund; Leif Bergkvist Journal: Ups J Med Sci Date: 2014-05-26 Impact factor: 2.384
Authors: Hanna Dillekås; Romano Demicheli; Ilaria Ardoino; Svein A H Jensen; Elia Biganzoli; Oddbjørn Straume Journal: Breast Cancer Res Treat Date: 2016-06-15 Impact factor: 4.872
Authors: Giulia Uitenbosch; Daniel Sng; Hugo N Carvalho; Juan P Cata; Hans D De Boer; Gabor Erdoes; Luc Heytens; Fernande Jane Lois; Anne-Françoise Rousseau; Paolo Pelosi; Patrice Forget; David Nesvadba Journal: J Clin Med Date: 2022-06-17 Impact factor: 4.964
Authors: Luke V Selby; Ana Fernandez-Bustamante; Aslam Ejaz; Ana Gleisner; Timothy M Pawlik; David J Douin Journal: J Gastrointest Surg Date: 2021-06-07 Impact factor: 3.267
Authors: Ho Bum Cho; Mun Gyu Kim; Sun Young Park; Sanghoon Song; Youn Sil Jang; Suyeon Park; Hyun Keun Lee; Jae Hwa Yoo; Ji Won Chung; Sang Ho Kim Journal: PLoS One Date: 2021-07-22 Impact factor: 3.240