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 (I ² =0%, RR: 1.18, 95% CI: 1.07– 1.30, P =0.001) but a lower incidence of postoperative nausea and vomiting (PONV) (I ²  =25.5%, RR: 0.71, 95% CI: 0.62– 0.81, P < 0.001) and postoperative rescue antiemetics (I ² =0%, RR: 0.69, 95% CI: 0.58– 0.82, P < 0.001). Propofol-based intravenous anaesthesia preserved nature killer cell cytotoxicity (I ² =86.2%, SMD: 0.76, 95% CI: 0.13– 1.39, P =0.018), decreased IL-6 level (I ² =98.0%, SMD: − 3.09, 95% CI: − 5.70– − 0.48, P =0.021) and neutrophil-to-lymphocyte ratio (I ² =0%, SMD: − 0.28, 95% CI: − 0.53– − 0.03, P =0.030), and increased 2-year recurrence-free survival rate (I ² =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: inhalational anaesthesia, propofol, breast cancer, surgery, outcome, analgesia