Anesthesia Type during Cancer Surgery: Results of the GA-CARES Randomized, Multicenter Trial.

Summary

In this multicenter randomized trial of 1,763 patients undergoing high-risk cancer resections, propofol maintenance anesthesia did not improve overall survival compared with volatile agents. Per-protocol analyses suggested higher mortality in the propofol group at 2 years, with no benefit in disease-free survival.

Key Findings

• Intent-to-treat: no survival advantage with propofol vs volatile (HR 1.16; 95% CI 0.96–1.41; P=0.115).
• Per-protocol: higher 2-year mortality in propofol group (25.5% vs 20%; HR 1.31; 95% CI 1.05–1.64; P=0.017).
• No improvement in disease-free survival with propofol (HR 1.10; 95% CI 0.9–1.36; P=0.428).
• High protocol adherence: 95.9% received assigned anesthetic exclusively.

Clinical Implications

Volatile general anesthetics are a safe choice for cancer surgery from an oncologic outcomes perspective; routine switching to propofol for presumed survival benefit is unwarranted. Focus should shift to optimizing comprehensive perioperative cancer care pathways.

Limitations

• Partially blinded design may introduce bias in perioperative management.
• Heterogeneity across cancer types; not powered for individual tumor-specific effects.

Future Directions

Investigate mechanistic immunologic effects of anesthetic agents in defined tumor types and integrate anesthesia within standardized oncologic ERAS pathways to optimize long-term outcomes.