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Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 5/2019

01-05-2019 | NSCLC | Review Article/Brief Review

Anesthetic technique and cancer outcomes: a meta-analysis of total intravenous versus volatile anesthesia

Authors: Andrea Yap, FANZCA, Maria A. Lopez-Olivo, PhD, Julia Dubowitz, MBBS, Jonathan Hiller, FANZCA, Bernhard Riedel, PhD, the Global Onco-Anesthesia Research Collaboration Group

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 5/2019

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Abstract

Purpose

Cancer-related mortality, a leading cause of death worldwide, is often the result of metastatic disease recurrence. Anesthetic techniques have varying effects on innate and cellular immunity, activation of adrenergic-inflammatory pathways, and activation of cancer-promoting cellular signaling pathways; these effects may translate into an influence of anesthetic technique on long-term cancer outcomes. To further analyze the effects of propofol (intravenous) and volatile (inhalational gas) anesthesia on cancer recurrence and survival, we undertook a systematic review with meta-analysis.

Source

Databases were searched up to 14 November 2018. Comparative studies examining the effect of inhalational volatile anesthesia and propofol-based total intravenous anesthesia (TIVA) on cancer outcomes were included. The Newcastle Ottawa Scale (NOS) was used to assess methodological quality and bias. Reported hazard ratios (HRs) were pooled and 95% confidence intervals (CIs) calculated.

Principal findings

Ten studies were included; six studies examined the effect of anesthetic agent type on recurrence-free survival following breast, esophageal, and non-small cell lung cancer (n = 7,866). The use of TIVA was associated with improved recurrence-free survival in all cancer types (pooled HR, 0.78; 95% CI, 0.65 to 0.94; P < 0.01). Eight studies (n = 18,778) explored the effect of anesthetic agent type on overall survival, with TIVA use associated with improved overall survival (pooled HR, 0.76; 95% CI, 0.63 to 0.92; P < 0.01).

Conclusion

This meta-analysis suggests that propofol-TIVA use may be associated with improved recurrence-free survival and overall survival in patients having cancer surgery. This is especially evident where major cancer surgery was undertaken. Nevertheless, given the inherent limitations of studies included in this meta-analysis these findings necessitate prospective randomized trials to guide clinical practice.

Trial registration

PROSPERO (CRD42018081478); registered 8 October, 2018.
Appendix
Available only for authorised users
Literature
1.
Stewart BW, Wild C, International Agency for Research on Cancer; World Health Organization. World Cancer Report. Lyon, France - 2014. Geneva, Switzerland: International Agency for Research on Cancer WHO Press; 2014.
2.
Sullivan R, Alatise OI, Anderson BO, et al. Global cancer surgery: delivering safe, affordable, and timely cancer surgery. Lancet Oncol 2015; 16: 1193-224.CrossRefPubMed
3.
Dubowitz JA, Sloan EK, Riedel BJ. Implicating anaesthesia and the perioperative period in cancer recurrence and metastasis. Clin Exp Metastasis 2018; 35: 347-58.CrossRefPubMed
4.
Dillekas H, Demicheli R, Ardoino I, Jensen SA, Biganzoli E, Straume O. The recurrence pattern following delayed breast reconstruction after mastectomy for breast cancer suggests a systemic effect of surgery on occult dormant micrometastases. Breast Cancer Res Treat 2016; 158: 169-78.CrossRefPubMedPubMedCentral
5.
Hiller JG, Perry NJ, Poulogiannis G, Riedel B, Sloan EK. Perioperative events influence cancer recurrence risk after surgery. Nat Rev Clin Oncol 2018; 15: 205-18.CrossRefPubMed
6.
Ishikawa M, Tanaka S, Arai M, Genda Y, Sakamoto A. Differences in microRNA changes of healthy rat liver between sevoflurane and propofol anesthesia. Anesthesiology 2012; 117: 1245-52.CrossRefPubMed
7.
Sakamoto A, Imai J, Nishikawa A, et al. Influence of inhalation anesthesia assessed by comprehensive gene expression profiling. Gene 2005; 356: 39-48.CrossRefPubMed
8.
Byrne K, Levins KJ, Buggy DJ. Can anesthetic-analgesic technique during primary cancer surgery affect recurrence or metastasis? Can J Anesth 2016; 63: 184-92.CrossRefPubMed
9.
Soltanizadeh S, Degett TH, Gogenur I. Outcomes of cancer surgery after inhalational and intravenous anesthesia: a systematic review. J Clin Anesth 2017; 42: 19-25.CrossRefPubMed
10.
Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses - 2008. Available from URL: http://​www.​ohri.​ca/​programs/​clinical_​epidemiology/​oxford.​asp (accessed January 2019).
11.
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010; 25: 603-5.CrossRefPubMed
12.
Enlund M, Berglund A, Andreasson K, Cicek C, Enlund A, Bergkvist L. The choice of anaesthetic–sevoflurane or propofol–and outcome from cancer surgery: a retrospective analysis. Ups J Med Sci 2014; 119: 251-61.CrossRefPubMedPubMedCentral
13.
Jun IJ, Jo JY, Kim JI, et al. Impact of anesthetic agents on overall and recurrence-free survival in patients undergoing esophageal cancer surgery: a retrospective observational study. Sci Rep 2017; 7: 14020.CrossRefPubMedPubMedCentral
14.
Kim MH, Kim DW, Kim JH, Lee KY, Park S, Yoo YC. Does the type of anesthesia really affect the recurrence-free survival after breast cancer surgery? Oncotarget 2017; 8: 90477-87.PubMedPubMedCentral
15.
Lee JH, Kang SH, Kim Y, Kim HA, Kim BS. Effects of propofol-based total intravenous anesthesia on recurrence and overall survival in patients after modified radical mastectomy: a retrospective study. Korean J Anesthesiol 2016; 69: 126-32.CrossRefPubMedPubMedCentral
16.
Oh TK, Kim K, Jheon S, et al. Long-term oncologic outcomes for patients undergoing volatile versus intravenous anesthesia for non-small cell lung cancer surgery: a retrospective propensity matching analysis. Cancer Control 2018; DOI: 10.1177/1073274818775360.
17.
Wigmore TJ, Mohammed K, Jhanji S. Long-term survival for patients undergoing volatile versus IV anesthesia for cancer surgery: a retrospective analysis. Anesthesiology 2016; 124: 69-79.CrossRefPubMed
18.
Wu ZF, Lee MS, Wong CS, et al. Propofol-based total intravenous anesthesia is associated with better survival than desflurane anesthesia in colon cancer surgery. Anesthesiology 2018; 129: 932-41.CrossRefPubMed
19.
Yan T, Zhang GH, Wang BN, Sun L, Zheng H. Effects of propofol/remifentanil-based total intravenous anesthesia versus sevoflurane-based inhalational anesthesia on the release of VEGF-C and TGF-β and prognosis after breast cancer surgery: a prospective, randomized and controlled study. BMC Anesthesiol 2018; 18: 131.CrossRefPubMedPubMedCentral
20.
Yoo S, Lee HB, Han W, et al. Total intravenous anesthesia versus inhalation anesthesia for breast cancer surgery: a retrospective cohort study. Anesthesiology 2019; 130: 31-40.CrossRefPubMed
21.
Zheng X, Wang Y, Dong L, et al. Effects of propofol-based total intravenous anesthesia on gastric cancer: a retrospective study. Onco Targets Ther 2018; 11: 1141-8.CrossRefPubMedPubMedCentral
22.
World Health Organization. Cancer Fact Sheet. 2018 [cited 01/07/2018. Available from URL: http://​www.​who.​int/​news-room/​fact-sheets/​detail/​cancer (accessed January 2019).
23.
Sessler DI, Riedel B. Anesthesia and cancer recurrence: context for divergent study outcomes. Anesthesiology 2019; 130: 3-5.CrossRefPubMed
24.
National Cancer Institute. Surveillance, Epidemiology, and End Results Program. Available from URL: https://​seer.​cancer.​gov/​ (accessed January 2019).
25.
Yuki K, Bu W, Xi J, Shimaoka M, Eckenhoff R. Propofol shares the binding site with isoflurane and sevoflurane on leukocyte function-associated antigen-1. Anesth Analg 2013; 117: 803-11.CrossRefPubMed
26.
Iwasaki M, Zhao H, Jaffer T, et al. Volatile anaesthetics enhance the metastasis related cellular signalling including CXCR2 of ovarian cancer cells. Oncotarget 2016; 7: 26042-56.CrossRefPubMedPubMedCentral
27.
Wu GJ, Chen WF, Sung CS, et al. Isoflurane attenuates dynorphin-induced cytotoxicity and downregulation of Bcl-2 expression in differentiated neuroblastoma SH-SY5Y cells. Acta Anaesthesiol Scand 2009; 53: 55-60.CrossRefPubMed
28.
Ecimovic P, McHugh B, Murray D, Doran P, Buggy DJ. Effects of sevoflurane on breast cancer cell function in vitro. Anticancer Res 2013; 33: 4255-60.PubMed
29.
Kawaraguchi Y, Horikawa YT, Murphy AN, et al. Volatile anesthetics protect cancer cells against tumor necrosis factor-related apoptosis-inducing ligand-induced apoptosis via caveolins. Anesthesiology 2011; 115: 499-508.CrossRefPubMed
30.
Huang H, Benzonana LL, Zhao H, et al. Prostate cancer cell malignancy via modulation of HIF-1alpha pathway with isoflurane and propofol alone and in combination. Br J Cancer 2014; 111: 1338-49.CrossRefPubMedPubMedCentral
31.
Deegan CA, Murray D, Doran P, Ecimovic P, Moriarty DC, Buggy DJ. Effect of anaesthetic technique on oestrogen receptor-negative breast cancer cell function in vitro. Br J Anaesth 2009; 103: 685-90.CrossRefPubMed
32.
Zhang D, Zhou XH, Zhang J, et al. Propofol promotes cell apoptosis via inhibiting HOTAIR mediated mTOR pathway in cervical cancer. Biochem Biophys Res Commun 2015; 468: 561-7.CrossRefPubMed
33.
Wu KC, Yang ST, Hsu SC, et al. Propofol induces DNA damage in mouse leukemic monocyte macrophage RAW264.7 cells. Oncol Rep 2013; 30: 2304-10.
34.
Ye Z, Jingzhong L, Yangbo L, Lei C, Jiandong Y. Propofol inhibits proliferation and invasion of osteosarcoma cells by regulation of microRNA-143 expression. Oncol Res 2013; 21: 201-7.CrossRefPubMed
35.
Wu KC, Yang ST, Hsia TC, et al. Suppression of cell invasion and migration by propofol are involved in down-regulating matrix metalloproteinase-2 and p38 MAPK signaling in A549 human lung adenocarcinoma epithelial cells. Anticancer Res 2012; 32: 4833-42.PubMed
36.
Stollings LM, Jia LJ, Tang P, Dou H, Lu B, Xu Y. Immune modulation by volatile anesthetics. Anesthesiology 2016; 125: 399-411.CrossRefPubMed
37.
38.
Buckley A, McQuaid S, Johnson P, Buggy DJ. Effect of anaesthetic technique on the natural killer cell anti-tumour activity of serum from women undergoing breast cancer surgery: a pilot study. Br J Anaesth 2014; 113(Suppl 1): i56-62.CrossRefPubMed
39.
Melamed R, Bar-Yosef S, Shakhar G, Shakhar K, Ben-Eliyahu S. Suppression of natural killer cell activity and promotion of tumor metastasis by ketamine, thiopental, and halothane, but not by propofol: mediating mechanisms and prophylactic measures. Anesth Analg 2003; 97: 1331-9.CrossRefPubMed
40.
Takeuchi H, Maehara Y, Tokunaga E, Koga T, Kakeji Y, Sugimachi K. Prognostic significance of natural killer cell activity in patients with gastric carcinoma: a multivariate analysis. Am J Gastroenterol 2001; 96: 574-8.CrossRefPubMed
41.
Ben-Eliyahu S, Page GG, Yirmiya R, Shakhar G. Evidence that stress and surgical interventions promote tumor development by suppressing natural killer cell activity. Int J Cancer 1999; 80: 880-8.CrossRefPubMed
42.
Seth R, Tai LH, Falls T, et al. Surgical stress promotes the development of cancer metastases by a coagulation-dependent mechanism involving natural killer cells in a murine model. Ann Surg 2013; 258: 158-68.CrossRefPubMed
43.
Ziello JE, Jovin IS, Huang Y. Hypoxia-inducible factor (HIF)-1 regulatory pathway and its potential for therapeutic intervention in malignancy and ischemia. Yale J Biol Med 2007; 80: 51-60.PubMedPubMedCentral
44.
Benzonana LL, Perry NJ, Watts HR, et al. Isoflurane, a commonly used volatile anesthetic, enhances renal cancer growth and malignant potential via the hypoxia-inducible factor cellular signaling pathway in vitro. Anesthesiology 2013; 119: 593-605.CrossRefPubMed
45.
Kehlet H. Manipulation of the metabolic response in clinical practice. World J Surg 2000; 24: 690-5.CrossRefPubMed
46.
Lennard TW, Shenton BK, Borzotta A, et al. The influence of surgical operations on components of the human immune system. Br J Surg 1985; 72: 771-6.CrossRefPubMed
47.
Beecher SM, O’Leary DP, McLaughlin R, Sweeney KJ, Kerin MJ. Influence of complications following immediate breast reconstruction on breast cancer recurrence rates. Br J Surg 2016; 103: 391-8.CrossRefPubMed
48.
Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg 2011; 253: 890-9.CrossRefPubMed
49.
de la Gala F, Pineiro P, Reyes A, et al. Postoperative pulmonary complications, pulmonary and systemic inflammatory responses after lung resection surgery with prolonged one-lung ventilation. Randomized controlled trial comparing intravenous and inhalational anaesthesia. Br J Anaesth 2017; 119: 655-63.
50.
Chang YT, Wu CC, Tang TY, Lu CT, Lai CS, Shen CH. Differences between total intravenous anesthesia and inhalation anesthesia in free flap surgery of head and neck cancer. PLoS One 2016; 11: e0147713.CrossRefPubMedPubMedCentral
51.
Aloia TA, Zimmitti G, Conrad C, Gottumukalla V, Kopetz S, Vauthey JN. Return to intended oncologic treatment (RIOT): a novel metric for evaluating the quality of oncosurgical therapy for malignancy. J Surg Oncol 2014; 110: 107-14.CrossRefPubMedPubMedCentral
52.
Lim A, Braat S, Hiller J, Riedel B. Inhalational versus propofol-based total intravenous anaesthesia: practice patterns and perspectives among Australasian anaesthetists. Anaesth Intensive Care 2018; 46: 480-7.CrossRefPubMed
53.
Pandit JJ, Andrade J, Bogod DG, et al. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors. Br J Anaesth 2014; 113: 549-59.CrossRefPubMed
Metadata
Title
Anesthetic technique and cancer outcomes: a meta-analysis of total intravenous versus volatile anesthesia
Authors
Andrea Yap, FANZCA
Maria A. Lopez-Olivo, PhD
Julia Dubowitz, MBBS
Jonathan Hiller, FANZCA
Bernhard Riedel, PhD
the Global Onco-Anesthesia Research Collaboration Group
Publication date
01-05-2019
Publisher
Springer International Publishing
Published in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 5/2019
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-019-01330-x

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