Impact of anesthetic drugs and modalities on the postoperative outcomes in cancer patients: a literature review.

BACKGROUND

Growing evidence suggests that perioperative anesthesia management may influence long-term oncologic outcomes. This review synthesizes the existing evidence on the impact of anesthetic drugs and modalities on postoperative immunity, recurrence, and survival in cancer patients.

METHODS

A systematic literature search was conducted in PubMed, Embase, Cochrane Library, and Web of Science from January 2000 to October 2025. Keywords included combinations of "anesthesia," "anesthetic," "cancer," "oncology," "postoperative," "recurrence," "immunity," and "survival." Clinical trials, cohort studies, and meta-analyses were included. Case reports and non-English studies were excluded.

RESULTS

Anesthetic choices exert multidimensional effects. Total intravenous anesthesia (TIVA) with propofol and regional anesthesia (RA) techniques are associated with better preservation of natural killer (NK) cell and T-lymphocyte function compared to volatile anesthetics and high-dose opioids. Opioids, particularly morphine, demonstrate dose-dependent immunosuppression (15-30% NK cell reduction). Meta-analyses indicate RA may reduce recurrence risk (OR = 0.82, p < 0.01). However, conflicting evidence exists, with large retrospective and some randomized controlled trials (RCTs) showing no significant survival difference between TIVA and volatile anesthesia. Technological advances like circulating tumor DNA (ctDNA) monitoring and AI-driven analgesic algorithms promise personalized management.

CONCLUSION

While preclinical and clinical data suggest that anesthetic strategy can modulate cancer-related outcomes, the evidence is heterogeneous. The observed benefits may be context-dependent, influenced by tumor type, surgical stress, and patient factors. There is an urgent need for large-scale, prospective RCTs with standardized endpoints to establish causal relationships and inform evidence-based, personalized anesthesia protocols for oncology patients.