Publish: March 1st, 2024.
Radiol Oncol 2024; 58(1): 9-14.
doi: 10.2478/raon-2024-0012
To the editor
I read with a great interest the review recently published in Radiology and Oncology by Potocnik et al.1 Upon examination, I have identified a critical discrepancy between the review’s main text and the cited meta-analysis2 results, which seems to have led to a significant misunderstanding in the presentation of the findings.
The review states that in a recent meta-analysis2, patients with breast, esophageal, or non-small cell lung cancer had improved recurrence-free survival after receiving volatile anesthesia (VA) and that overall survival was longer after VA than after total intravenous anesthesia (TIVA). This statement contradicts the findings of the cited meta-analysis, which actually shows that TIVA is associated with improved outcomes both in terms of recurrence-free survival (pooled Hazard Ratio [HR], 0.78; 95% Confidence Interval [CI], 0.65 to 0.94; P < 0.01) and overall survival (pooled HR, 0.76; 95% CI, 0.63 to 0.92; P < 0.01) across several cancer types, including breast, esophageal, colorectal, gastric, and non-small cell lung cancer.
Interestingly, the conclusion section of the review correctly highlights the potential anti-inflammatory, antioxidant, and possibly antitumor effects of propofol (a common TIVA agent) compared to the proinflammatory effects of volatile anesthetics, which could accelerate metastasis. This conclusion aligns with the meta-analysis findings that favor TIVA over VA, suggesting a potential oversight or error in the review’s main text.
Given the significance of these findings for clinical practice and the potential impact on patient care, I believe a clarification and correction of the discrepancy in the review’s main text is crucial. Accurate representation of the meta-analysis results is essential for guiding future research and clinical decisions regarding anesthesia choice in cancer surgery.
[1] Notes
No potential conflict of interest relevant to this letter was report.
References
Potocnik I; Kerin-Povsic M, Markovic-Bozic J. The influence of anaesthetic technique on cancer growth. Radiol Oncol 2024; 58(1): 9–14. Available at: https://www.radioloncol.com/index.php/ro/article/view/4210
I PotocnikM Kerin-PovsicJ Markovic-BozicThe influence of anaesthetic technique on cancer growthRadiol Oncol2024581914Available at: https://www.radioloncol.com/index.php/ro/article/view/4210
Yap A, Lopez-Olivo MA, Dubowitz J, Hiller J, Riedel B; Global OncoAnesthesia Research Collaboration Group. Anesthetic technique and cancer outcomes: a meta-analysis of total intravenous versus volatile anesthesia. Can J Anaesth 2019; 66: 546–61. doi: 10.1007/s12630-019-01330-x
A YapMA Lopez-OlivoJ DubowitzJ HillerB RiedelGlobal OncoAnesthesia Research Collaboration GroupAnesthetic technique and cancer outcomes: a meta-analysis of total intravenous versus volatile anesthesiaCan J Anaesth2019665466110.1007/s12630-019-01330-x
Responses
The authors reply
While reviewing the article1, we realised that we had made a mistake. Instead of VIMA, we should have written TIVA. Please, accept our apology. In the article, we also cited studies that concluded that volatile anaesthetics have anti-inflammatory action and so might act anti carcinogenic.2,3,4,5,6 In the conclusion we also wrote that this area is still quite unexplored and that studies have led to very controversial results. Regarding that please, find enclosed an additional reference of Wang J et al.7, who proved that volatile anaesthetics have a rule in the anti-cancer relevant signalling. Therefore, above mentioned mistake luckily did not have an effect on the message of the article.
Assist. Prof. Iztok Potocnik, M.D., Ph.D.
Institute of Oncology Ljubljana, Ljubljana, Slovenia
E-mail: vpotocnik@onko-i.si
Prof. Jasmina Markovic-Bozic, M.D., Ph.D.
University Clinical Centre Ljubljana, Ljubljana, Slovenia
[2] Notes
No potential conflict of interest relevant to this letter was report.
References
Potocnik I; Kerin-Povsic M, Markovic-Bozic J. The influence of anaesthetic technique on cancer growth. Radiol Oncol 2024; 58(1): 9–14. Available at: https://www.radioloncol.com/index.php/ro/article/view/4210
I PotocnikM Kerin-PovsicJ Markovic-BozicThe influence of anaesthetic technique on cancer growthRadiol Oncol2024581914Available at: https://www.radioloncol.com/index.php/ro/article/view/4210
El Azab SR, Rosseel PM, De Lange JJ, van Wijk EM, van Strik R, Scheffer GJ. Effect of VIMA with sevoflurane versus TIVA with propofol or midazolamsufentanil on the cytokine response during CABG surgery. Eur J Anaesthesiol 2002; 19: 276–82. doi: 10.1017/s0265021502000443 41
SR El AzabPM RosseelJJ De LangeEM van WijkR van StrikGJ SchefferEffect of VIMA with sevoflurane versus TIVA with propofol or midazolamsufentanil on the cytokine response during CABG surgeryEur J Anaesthesiol2002192768210.1017/s0265021502000443 41
Minou AF, Dzyadzko AM, Shcherba AE, Rummo OO. The influence of pharmacological preconditioning with sevoflurane on incidence of early allograft dysfunction in liver transplant recipients. Anesthesiol Res Pract 2012; 2012: 930487. doi: 10.1155/2012/930487 42
AF MinouAM DzyadzkoAE ShcherbaOO RummoThe influence of pharmacological preconditioning with sevoflurane on incidence of early allograft dysfunction in liver transplant recipientsAnesthesiol Res Pract2012201293048710.1155/2012/930487 42
Jerin A, Pozar-Lukanovic N, Sojar V, Stanisavljevic D, Paver-Erzen V, Osredkar J. Balance of pro- and anti-inflammatory cytokines in liver surgery. Clin Chem Lab Med 2003; 41: 899–903. doi: 10.1515/CCLM.2003.136 43
A JerinN Pozar-LukanovicV SojarD StanisavljevicV Paver-ErzenJ OsredkarBalance of pro- and anti-inflammatory cytokines in liver surgeryClin Chem Lab Med20034189990310.1515/CCLM.2003.136 43
Jabaudon M, Zhai R, Blondonnet R, Bonda WLM. Inhaled sedation in the intensive care unit. Anaesth Crit Care Pain Med 2022; 41: 101133. doi: 10.1016/j.accpm.2022.101133 44
M JabaudonR ZhaiR BlondonnetWLM BondaInhaled sedation in the intensive care unitAnaesth Crit Care Pain Med20224110113310.1016/j.accpm.2022.101133 44
Song Z, Tan J. Effects of anesthesia and anesthetic techniques on metastasis of lung cancers: a narrative review. Cancer Manag Res 2022; 14: 189–204. doi: 10.2147/CMAR.S343772 45
Z SongJ TanEffects of anesthesia and anesthetic techniques on metastasis of lung cancers: a narrative reviewCancer Manag Res20221418920410.2147/CMAR.S343772 45
Oh CS, Park HJ, Piao L, Sohn KM, Koh SE, Hwang DY, et al. Expression profiles of immune cells after propofol or sevoflurane anesthesia for colorectal cancer surgery: a prospective double-blind randomized trial. Anesthesiology 2022; 136: 448–58. doi: 10.1097/ALN.0000000000004119
CS OhHJ ParkL PiaoKM SohnSE KohDY HwangExpression profiles of immune cells after propofol or sevoflurane anesthesia for colorectal cancer surgery: a prospective double-blind randomized trialAnesthesiology20221364485810.1097/ALN.0000000000004119
Wang J, Cheng CS, Lu Y, Sun S, Huang S. Volatile anesthetics regulate anti-cancer relevant signalling. Front Oncol 2021; 26: 11: 610514. doi: 10.3389/fonc.2021.610514
J WangCS ChengY LuS SunS HuangVolatile anesthetics regulate anti-cancer relevant signallingFront Oncol2021261161051410.3389/fonc.2021.610514