The influence of anaesthesia on cancer growth

I read with a great interest the review recently published in Radiology and Oncology by Potocnik et al.¹ Upon examination, I have identified a critical discrepancy between the review’s main text and the cited meta-analysis² results, which seems to have led to a significant misunderstanding in the presentation of the findings.

The review states that in a recent meta-analysis², patients with breast, esophageal, or non-small cell lung cancer had improved recurrence-free survival after receiving volatile anesthesia (VA) and that overall survival was longer after VA than after total intravenous anesthesia (TIVA). This statement contradicts the findings of the cited meta-analysis, which actually shows that TIVA is associated with improved outcomes both in terms of recurrence-free survival (pooled Hazard Ratio [HR], 0.78; 95% Confidence Interval [CI], 0.65 to 0.94; P < 0.01) and overall survival (pooled HR, 0.76; 95% CI, 0.63 to 0.92; P < 0.01) across several cancer types, including breast, esophageal, colorectal, gastric, and non-small cell lung cancer.

Interestingly, the conclusion section of the review correctly highlights the potential anti-inflammatory, antioxidant, and possibly antitumor effects of propofol (a common TIVA agent) compared to the proinflammatory effects of volatile anesthetics, which could accelerate metastasis. This conclusion aligns with the meta-analysis findings that favor TIVA over VA, suggesting a potential oversight or error in the review’s main text.

Given the significance of these findings for clinical practice and the potential impact on patient care, I believe a clarification and correction of the discrepancy in the review’s main text is crucial. Accurate representation of the meta-analysis results is essential for guiding future research and clinical decisions regarding anesthesia choice in cancer surgery.