Impact of Anaesthetic Technique on Cancer Recurrence and Long-Term Survival after Oncologic Surgery: A systematic review and meta-analysis

Emerging evidence suggests anesthetic techniques might influence cancer outcomes via immunomodulation, but findings remain inconclusive. Hence, this systematic review was conducted to evaluate the impact of general (GA) versus regional anesthesia (RA) or Total intravenous anesthesia (TIVA) on cancer recurrence and survival. Following PRISMA guidelines, a systematic review and meta-analysis was conducted of 18 studies (13,169 patients) from PubMed, Embase, and Cochrane Library (2000–2024). Risk of bias was assessed using ROB2 and ROBINS-E. Random-effects models pooled hazard ratios (HRs) for survival/recurrence, with subgroup analyses by tumor type. It was found that TIVA improved survival in gastric cancer (HR=0.72, 95% CI: 0.58–0.89) and cholangiocarcinoma (HR=0.64, 95% CI: 0.44–0.93), while colorectal cancer showed neutral effects (HR=1.01, 95% CI: 0.74–1.28). Prostate cancer results conflicted (TIVA HR=0.61 vs. opioid-sparing HR=1.98). High heterogeneity (I²=79.3%) reflected variability in protocols and tumor biology. Anesthetic choice might have tumor-specific effects, with TIVA favoring certain adenocarcinomas. Clinical decisions should consider cancer type until further RCTs clarify optimal protocols.