Inhalation vs Total Intravenous Anesthesia in Cancer Surgery: Where is the «Pendulum» Now? (Meta-Analysis and Review)

Abstract

Comparative studies on the efficacy and safety of Inhalation Anesthesia (IA) and Total IntraVenous Anesthesia (TIVA) have been performed for many years, and the results were various.The aim of this study was to evaluate new data on the clinical efficacy of anesthetic preconditioning, the difference between inhalation and intravenous anesthesia on cardiac protection and clinically relevant outcomes in cancer surgery.Materials and methods. We carried out a systematic review and meta-analysis on searches and analysis of the literature over the past five years in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Results. Out of the 759 articles which were initially identified, we selected 3 studies regarding the clinical significance of anesthetic cardioprotection and 10 studies comparing IA and TIVA in patients undergoing surgery for malignant diseases.Two meta-analyses and one multi-regional clinical trial (MRCT) suggest that further studies of the effectiveness of anesthetic cardioprotection is futile.A meta-analysis of 9 retrospective cohort studies and 1 MRCT showed a detrimental effect of IA on 3-year survival in surgical oncology (Hazard Ratio (HR): 1.73 (1.36; 1.96) Heterogeneity: Q = 8.336, df = 3, I2; f2= 64.01, overall effect analysis: Z = 2.386 (P<0.017)). Analysis of 5-year mortality did not reveal any differences, although it did not remove any doubts about the possible negative effect of the use of IA in surgical oncology.Conclusion. Due to the futility of the previous efforts, the authors suggest not starting new studies aimed at finding evidence of the effectiveness of anesthetic cardioprotection on clinically relevant outcomes. However, since cohort studies indicate a possible beneficial effect of the use of TIVA in surgical oncology, the authors suggest conducting a serious comparative MRCT in this setting.

Keywords

• anesthesia related outcomes, perioperative mortality
• volatile anesthesia vs tiva
• anesthesia for cancer patients
• anesthetic preconditioning