Survival outcomes following total intravenous versus volatile anesthesia in esophagogastric cancer surgery: a systematic review and meta-analysis

Esophagogastric cancers remain among the leading causes of cancer-related mortality worldwide. Surgical resection represents the primary curative treatment strategy; however, perioperative factors may influence long-term oncological outcomes. Experimental and clinical evidence suggests that anesthetic techniques may affect tumor progression and recurrence through immunological and oncological pathways. Total intravenous anesthesia (TIVA) has been proposed to exert immunomodulatory and antitumor effects compared to volatile anesthesia (VA), although evidence remains inconclusive. This systematic review and meta-analysis aimed to evaluate the impact of TIVA versus volatile anesthesia on survival outcomes in patients undergoing esophagogastric cancer surgery.

A systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines. PubMed and Scopus were searched for studies published between 2010 and 2025 comparing TIVA with volatile anesthesia in adult patients undergoing curative surgery for esophageal or gastric cancer. The primary outcome was overall survival (OS). Secondary outcomes included recurrence-free survival (RFS), early mortality, operation time, and postoperative hospital stay. Pooled hazard ratios (HR), risk ratios (RR), and mean differences (MD) with 95% confidence intervals (CI) were calculated using random-effects models.