Effect of regional anaesthesia only versus general anaesthesia on cancer recurrence rate: A systematic review and meta-analysis with trial sequential analysis.

ABSTRACT

OBJECTIVES: There is growing evidence on the influence of general anaesthesia (GA) in promoting the proliferation of cancer cells. The benefits of regional anaesthesia (RA) on cancer recurrence rate in cancer surgery remains unclear in the literature. The primary objective of this review was to examine the effect of RA on the incidence of post-operative cancer recurrence rate in cancer resection surgery. DESIGN: Systematic review and meta-analysis with trial sequential analysis. DATA SOURCES Medline, EMBASE and CENTRAL were systematically searched from its inception until April 2020. ELIGIBILITY CRITERIA All randomized control trials and observational studies comparing RA only versus GA in cancer resection surgery were included. Case report, case series and editorials were excluded. RESULTS: Ten retrospective observational studies (n = 9708; 4567 GA vs 5141 RA) were included for qualitative and quantitative meta-analysis. In comparison to GA, RA was not significantly associated with a lower cancer recurrence rate in cancer resection surgery (odds ratio 1.01, 95% CI 0.67 to 1.53, p = 0.95, certainty of evidence = very low). However, the trial sequential analysis for cancer recurrence rate was inconclusive. Our analysis demonstrated no significant difference between the RA and GA groups in the overall survival rate (odds ratio 1.51, 95% CI 0.65 to 3.51, p = 0.34, certainty of evidence = very low), time to cancer recurrence (mean difference 1.45 months, 95% CI -8.69 to 11.59, p = 0.78, certainty of evidence = very low), cancer-related mortality (odds ratio 1.79, 95% CI 0.57 to 5.62, p = 0.32, certainty of evidence = very low). CONCLUSIONS: Given the low level of evidence and underpowered trial sequential analysis, our review neither support nor oppose that the use of RA was associated with lower incidence of cancer recurrence rate than GA in cancer resection surgery. TRIAL REGISTRATION CRD42020163780.