Propofol-based IV anesthesia improves survival during cancer surgery: Study
Taiwan: Cancer patients who receive propofol-based total intravenous anesthesia (TIVA) versus volatile anesthesia during surgery have better overall survival, finds a recent study in the journal Anesthesia & Analgesia. However, according to the authors, there is a need for further large-scaled, high-quality randomized control trials for confirming the findings.
Whether propofol helps in survival benefit versus volatile anesthetics during cancer surgery remains inconclusive. The primary aim of the systematic review and meta-analysis by Ming-Chang Kao, School of Medicine, Tzu Chi University, Hualien, Taiwan, and colleagues, was to to compare the effects of propofol-based TIVA with any volatile anesthesia on long-term oncological outcomes. Secondly, they aimed to compare propofol-based TIVA with specific volatile agents on long-term oncological outcomes.
For the study, the researchers searched the online databases from inception through March 3, 2020. It included randomized control trials and observational studies that compared the effects of propofol-based TIVA and volatile anesthesia on long-term oncological outcomes, which also reported hazard ratios (HR) as effect estimates.
Using the inverse variance method with a random-effects model, HR and 95% confidence intervals (CI) were calculated. Trial sequential analysis was incorporated to test if the results were subject to a type I or type II error.
A total of 19 retrospective observational studies were included.
Key findings of the study include:
- Patients who received propofol-based TIVA during cancer surgery were associated with significantly better overall survival than those who received volatile anesthesia (HR = 0.79).
- In contrast, no statistically significant difference was observed in recurrence-free survival between patients who received propofol-based TIVA and volatile anesthesia during cancer surgery (HR = 0.81).
- In the subgroup analysis by different volatile anesthetics, patients who received propofol-based TIVA were associated with better overall survival than those who received desflurane (HR = 0.54).
- In contrast, there was no statistically significant difference in overall survival between patients who received propofol-based TIVA and those who received sevoflurane (HR = 0.92).
- In the trial sequential analysis of overall survival, the cumulativez curve reached the required heterogeneity-adjusted information size and crossed the traditional significance boundary.
- In contrast, in the trial sequential analysis of recurrence-free survival, the cumulativez curve did not cross the traditional significance boundary. However, the required heterogeneity-adjusted information size has not yet been reached.
"Propofol-based TIVA is generally associated with better overall survival than volatile anesthesia during cancer surgery. Further large-scaled, high-quality randomized control trials are warranted to confirm our findings," concluded the authors.
The study titled, "Anesthesia and Long-term Oncological Outcomes: A Systematic Review and Meta-analysis," is published in the journal Anesthesia & Analgesia.