Impact of propofol-based vs. volatile-based anaesthesia on survival and recurrence after cancer surgery: a systematic review and meta-analysis of randomised trials
In brief
Propofol anesthesia offers no survival or recurrence benefit in cancer surgery
A meta-analysis of 11 randomized trials involving 7,811 patients found that propofol-based anaesthesia did not improve overall survival, recurrence-free survival, or mortality compared with volatile anaesthesia, with hazard ratios near 1.0 and minimal heterogeneity. The evidence is high-certainty for mortality, while the effect on recurrence remains unresolved.
- Journal
- Anaesthesia (Q1)
- Published
- 17 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Ashmit Daiyan Mustafa, Pavan Shet, Sameen Shadman Sawdagar
- PMID
- 42605750
- DOI
- 10.1111/anae.70347
Why clinicians should know about it
- Picked for Surgery (top studies of the week, 23 August 2026): Systematic review of anaesthetic technique on cancer outcomes
- Picked for Anesthesiology and Pain Medicine (top studies of the week, 23 August 2026): Propofol vs volatile anaesthesia impact on cancer outcomes
Abstract
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.