Literature review associates TIVA and regional anesthesia with better immune preservation in cancer surgery

This literature review synthesized evidence from clinical trials, cohort studies, and meta-analyses to examine the impact of anesthetic drugs and modalities on postoperative outcomes in cancer patients. The review focused on perioperative care, comparing total intravenous anesthesia (TIVA) with propofol and regional anesthesia (RA) techniques against volatile anesthetics and high-dose opioids. Key outcomes of interest included postoperative immunity, recurrence, and survival.

The main findings suggest TIVA with propofol and RA are associated with better preservation of natural killer (NK) cell and T-lymphocyte function compared to the comparator techniques. Opioids, particularly morphine, demonstrated dose-dependent immunosuppression, with evidence of 15–30% NK cell reduction. For recurrence risk, RA was associated with a potential reduction, with an odds ratio of 0.82 (p < 0.05). Safety, tolerability, and detailed survival data were not reported.

Key limitations of the evidence base were not specified in the review. The authors explicitly note the findings represent associations, not causation. The practice relevance of these findings is not reported, and clinicians should interpret them with caution. The evidence does not establish that changing anesthetic technique directly improves clinical outcomes like survival, and decisions should be based on comprehensive patient factors and established perioperative guidelines.