Survival outcomes following total intravenous versus volatile anesthesia in esophagogastric cancer surgery: a systematic review and meta-analysis.

In 30 seconds

This systematic review and meta-analysis compared total intravenous anesthesia (TIVA) with volatile anesthesia in adults undergoing curative surgery for esophageal or gastric cancer. It included 13 studies—3 randomized trials and 10 retrospective studies—with 264,543 patients. Across eight studies reporting overall survival, TIVA was associated with better survival (HR 0.80, 95% CI 0.69-0.93; p = 0.003). The subgroup result was significant for gastrectomy but not esophagectomy. Recurrence-free survival and early mortality showed non-significant trends favoring TIVA; operation time and hospital stay did not differ significantly.

Key findings

• Overall survival favored TIVA across eight studies (HR 0.80, 95% CI 0.69-0.93; p = 0.003).
• For gastrectomy, TIVA was associated with improved survival (HR 0.74, 95% CI 0.60-0.91; p < 0.004); esophagectomy showed no significant difference (HR 0.89, 95% CI 0.73-1.10; p = 0.29).
• Recurrence-free survival and early mortality differences were not statistically significant (HR 0.91, 95% CI 0.77-1.06; p = 0.22; and HR 0.90, 95% CI 0.77-1.05; p = 0.17, respectively).
• Operation time and hospital stay did not differ significantly between anesthetic approaches.

Why it matters

Anesthetic technique is a potentially modifiable perioperative factor, and the pooled survival association raises the possibility that it may be relevant to long-term outcomes after upper gastrointestinal cancer surgery. However, the findings do not establish that TIVA causes improved survival, particularly because most included evidence was retrospective and results differed between gastrectomy and esophagectomy.

What to keep in mind

The evidence was predominantly retrospective and methodologically heterogeneous; only three included studies were randomized trials.