Total intravenous anesthesia improves overall survival in gastrectomy patients compared to volatile anesthesiaTIVA anesthesia may improve survival for certain stomach cancer surgeries

This meta-analysis evaluated the impact of anesthesia techniques on clinical outcomes in a large population of 264,543 adult patients undergoing curative surgery for esophageal or gastric cancer. The study compared total intravenous anesthesia (TIVA) against volatile anesthesia (VA) to determine differences in survival and perioperative metrics. The evidence base for this analysis included 3 randomized controlled trials and 10 retrospective studies.

In the primary outcome of overall survival (OS), TIVA was associated with significantly improved outcomes compared to VA (HR 0.80; 95% CI 0.69-0.93; p=0.003). When specifically analyzing the gastrectomy cohort, the benefit of TIVA was even more pronounced, with a significant improvement in overall survival (HR 0.74; 95% CI 0.60-0.91; p<0.004). However, in the esophagectomy cohort, no significant difference in overall survival was observed between TIVA and VA (HR 0.89; 95% CI 0.73-1.10; p=0.29).

Secondary outcomes provided further insight into the clinical course of these patients. Recurrence-free survival (RFS) showed a non-significant trend toward improvement with TIVA (HR 0.91; 95% CI 0.77-1.06; p=0.22). Similarly, early mortality showed a non-significant trend toward reduction with TIVA (HR 0.90; 95% CI 0.77-1.05; p=0.17). Regarding perioperative metrics, there was no statistically significant difference in operation time between the two groups (MD -3.81 min; 95% CI -10.75 to 3.13). Postoperative hospital stay also showed no statistically significant difference (MD -0.19 days; 95% CI -0.39 to 0.00; p=0.06).

Safety and tolerability data, including specific adverse event rates, serious adverse events, or discontinuation rates, were not reported in the included studies. Consequently, the specific safety profile of TIVA versus VA in this population cannot be quantified.

These results suggest a potential survival benefit for TIVA in gastrectomy patients, which may contrast with historical data where the superiority of one anesthetic method over another was not consistently established across all surgical types. However, the lack of significant findings in the esophagectomy group suggests that the benefits of TIVA may be specific to the surgical procedure or the underlying pathology of the gastric cancer cohort.

The evidence is limited by several factors. The primary limitation is the predominance of retrospective evidence, which can introduce significant selection bias. Furthermore, the study noted significant methodological heterogeneity among the included studies. These factors contribute to a lower level of certainty regarding the strength of the association between TIVA and improved survival.

Clinically, these findings suggest that TIVA may be associated with improved long-term survival outcomes compared with volatile anesthesia in patients undergoing esophagogastric cancer surgery, particularly in those undergoing gastrectomy. However, clinicians should not assume a survival benefit for esophagectomy patients or improvements in recurrence-free survival based on this data. Questions remain regarding the specific mechanisms by which TIVA might influence survival and the impact of TIVA on other perioperative complications that were not captured in this analysis.