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Association Between Anesthesia Delivered During Tumor Resection and Cancer Survival: a Systematic Review of a Mixed Picture with Constant Themes

  • Review Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Surgery is required for cure of most solid tumors, and general anesthesia is required for most cancer surgery. The vast majority of cancer surgery is facilitated by general anesthesia using volatile inhalational agents such as isoflurane and sevoflurane. Only recently have the immunologic and oncologic effect of inhalational agents, and their alternative, propofol-based total intravenous anesthesia (TIVA), come under investigation.

Methods

Between January 2019 and June 2020, English language articles on PubMed were searched for the keywords “Propofol” “TIVA” or “IV anesthesia” and either “cancer surgery” or “surgical oncology.” Duplicates were removes, manuscripts classified as either in vitro, animal, translational, or clinical studies, and their results summarized within these categories.

Results

In-vitro and translational data suggest that inhalational anesthetics are potent immunosuppressive and tumorigenic agents that promote metastasis, while propofol is anti-inflammatory, anti-tumorigenic, and prevents metastasis development. Clinically there is a recurring association, based largely on retrospective, single institution series, that TIVA is associated with significant improvements in disease-free interval and overall survival in a number of, but not all, solid tumors. The longer the surgery is, the more intense the surgical trauma is, the more aggressive the malignancy is, and the higher likelihood of an association is.

Discussion

Prospective randomized trials, coupled with basic science and translational studies, are needed to further define this association.

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Abbreviations

TIVA:

Total intravenous anesthesia

NK cell:

Natural killer cell

COX:

Cyclooxygenase

VEGF:

Vascular endothelial growth factor

PDGF:

Platelet-derived growth factor

MMPs:

Matrix metalloproteinases

PGE2 :

Prostaglandin E2

NET:

Neutrophil extracellular trap

vWF:

von Willebrand factor

TGFß:

Transforming growth factor beta

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Luke V. Selby, Aslam Ejaz & Timothy M. Pawlik

  2. Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA

    Luke V. Selby & Ana Gleisner

  3. Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA

    Ana Fernandez-Bustamante & David J. Douin

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  1. Luke V. Selby
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  2. Ana Fernandez-Bustamante
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  3. Aslam Ejaz
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Correspondence to David J. Douin.

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Selby, L.V., Fernandez-Bustamante, A., Ejaz, A. et al. Association Between Anesthesia Delivered During Tumor Resection and Cancer Survival: a Systematic Review of a Mixed Picture with Constant Themes. J Gastrointest Surg 25, 2129–2141 (2021). https://doi.org/10.1007/s11605-021-05037-7

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