Impact of propofol-based vs. volatile-based anaesthesia on survival and recurrence after cancer surgery: a systematic review and meta-analysis of randomised trials.

INTRODUCTION: Choice of peri-operative anaesthetic technique may influence cancer recurrence, survival and mortality following curative surgery. Conflicting evidence exists on whether propofol-based anaesthesia improves outcomes over volatile anaesthesia. This systematic review and meta-analysis examined evidence from randomised trials on overall survival and recurrence in adult patients having oncological surgery. METHODS: We systematically searched relevant databases for randomised trials comparing propofol-based with volatile-based anaesthesia in adults undergoing curative cancer surgery. In addition to narrative synthesis, random-effects meta-analysis was performed with exploratory trial sequential analysis. RESULTS: Eleven studies were included, comprising 3904 and 3907 patients assigned to propofol-based or volatile-based anaesthesia, respectively. Meta-analysis found no significant effect on overall or recurrence-free survival with a hazard ratio of 1.05 (95%CI 0.94-1.17, p = 0.42) and 1.06 (95%CI 0.95-1.19, p = 0.31), respectively. There was no significant effect on mortality (relative risk 1.03, 95%CI 0.94-1.13, p = 0.48). Similar results were found for recurrence (relative risk 0.92, 95%CI 0.76-1.12, p = 0.41). There was minimal detected heterogeneity in all analyses. DISCUSSION: Propofol-based and volatile-based anaesthesia yield similar long-term oncological outcomes, with no significant differences in survival or recurrence and minimal heterogeneity, supported by high-certainty evidence. Trial sequential analysis confirms mortality findings are robust while recurrence remains inconclusive.