Comparison of Outcomes After Breast Cancer Surgery Between Inhalational and Propofol-Based Intravenous Anaesthesia: A Systematic Review and Meta-Analysis

Abstract

Background: General anaesthesia is the commonly provided for breast cancer surgery, but the effects of inhalational anaesthesia and propofol-based intravenous anaesthesia on short- and long-term outcomes after breast cancer surgery are not clear. In this study, we conduct a meta-analysis of randomized controlled trials (RCTs) to explore the superior anaesthetic for breast cancer surgery patients.

Methods: We searched the Embase, Medline, Cochrane Library, Web of Science, CNKI, and Wanfang databases (up to January, 2021) for RCTs in which inhalational anaesthesia and propofol-based intravenous anaesthesia were compared and short- and long-term outcomes were assessed in breast cancer surgical patients. The meta-analysis was performed by Stata 12.0.

Results: Twenty RCTs with a total of 2201 patients were included. Compared with inhalational anaesthesia, propofol-based intravenous anaesthesia was associated with more postoperative rescue analgesia (I² =0%, RR: 1.18, 95% CI: 1.07-1.30, P=0.001) but a lower incidence of postoperative nausea and vomiting (PONV) (I² =25.5%, RR: 0.71, 95% CI: 0.62-0.81, P<0.001) and postoperative rescue antiemetics (I² =0%, RR: 0.69, 95% CI: 0.58-0.82, P<0.001). Propofol-based intravenous anaesthesia preserved nature killer cell cytotoxicity (I² =86.2%, SMD: 0.76, 95% CI: 0.13-1.39, P=0.018), decreased IL-6 level (I² =98.0%, SMD: -3.09, 95% CI: -5.70- -0.48, P=0.021) and neutrophil-to-lymphocyte ratio (I² =0%, SMD: -0.28, 95% CI: -0.53- -0.03, P=0.030), and increased 2-year recurrence-free survival rate (I² =0%, RR: 1.10, 95% CI: 1.00-1.20, P=0.043) but did not affect recurrence or the overall survival rate (P>0.05).

Conclusion: Propofol-based intravenous anaesthesia increases postoperative rescue analgesia but reduces PONV compared with inhalational anaesthesia in breast cancer surgery. The benefit of propofol over inhalational anaesthetics in the preservation of anti-cancer immunity is obvious, but it is difficult to conclude that propofol can exert long-term benefits due to the small sample size.

Keywords: analgesia; breast cancer; inhalational anaesthesia; outcome; propofol; surgery.