Effects of Anaesthetic Techniques on Cancer Recurrence and Survival: A Systematic Review and Meta-analysis
Notice bibliographique
Résumé
Introduction: Many anaesthetic agents and techniques are used in surgical oncology, yet their effects on cancer cells remain inconclusive. Some studies suggest that propofol-based Total Intravenous Anaesthesia (TIVA) and regional anaesthetic techniques may protect against cancer progression, while volatile anaesthetics and high-dose opioids could increase recurrence. Other research indicates that anaesthetics may have no effect. Aim: To evaluate the impact of General Anaesthesia (GA) supplemented with Regional Analgesia (RA) on Overall Survival (OS) in adult cancer surgery patients, as well as the effects of TIVA versus Inhalational Anaesthesia (INHA) on OS. Materials and Methods: The present systematic review and meta-analysis was conducted at King George’s Medical University, Lucknow, Uttar Pradesh, India, PUBMED/MEDLINE, EMBASE/Emtree, Google Scholar, and ResearchGate were searched. Original retrospective studies from 2005 to 2020 on adult cancer surgeries were included. Eligible studies involved primary cancer surgeries under general anaesthesia (TIVA or volatile) alone or with regional anaesthesia. Only studies published in English and providing numeric Hazard Ratios (HR) were considered. The selected studies were divided into two groups: 10 studies comparing GA with or without RA, and 13 studies comparing TIVA versus INHA. Forest plots were generated to analyse pooled data, and Begg’s funnel plots were used to assess publication bias. The Risk Ratio (RR) was used to measure dichotomous outcomes with 95% confidence intervals (CI). Heterogeneity was assessed using the τ² statistic, and a fixed-effects model was applied. The risk of bias in included studies was assessed using the Newcastle-Ottawa Scale (NOS). The GRADE system was applied to ascertain the level of evidence. Results: A total of 23 retrospective studies involving 67,550 patients were included. In the GA+RA versus GA comparison (10 studies, 46,425 patients), GA+RA was associated with improved overall survival (RR=0.91, 95% CI: 0.89-0.92) but showed no significant difference in recurrence-free survival (RR=1.01, 95% CI: 1.00-1.02). In the TIVA versus INHA comparison (13 studies, 21,125 patients), TIVA was associated with modestly better overall survival (RR=1.11, 95% CI: 1.09-1.13) and recurrencefree survival (RR=1.06, 95% CI: 1.04-1.08). Heterogeneity was low to moderate, and the quality of evidence was graded as low to moderate due to the retrospective design. All 23 studies were evaluated using NOS, with scores ranging from 6 to 9. Most studies scored 7 or higher, indicating moderate to high quality. Evidence certainty was rated as low to moderate for both OS and RFS outcomes across comparisons due to the retrospective nature of the studies. Conclusion: This study provides evidence that anaesthetic technique may impact long-term outcomes in patients undergoing cancer surgery. General anaesthesia combined with regional analgesia (GA+RA) was associated with improved OS, although no significant difference was observed in recurrence-free survival (RFS). Additionally, TIVA showed a survival benefit over INHA, with improvements in both OS and RFS. Despite these findings, the overall certainty of evidence is limited by the retrospective design of the included studies.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,007 | 0,034 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,003 | 0,001 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».