Regional anesthesia did not improve postoperative long-term survival of tumor patients: a systematic review and meta-analysis of randomized controlled trials

Abstract

Objective: Experimental research and clinical trials have reported a positive effect of regional anesthesia (RA) on prognosis of cancers. We systematically reviewed the efficacy of RA on recurrence-free survival (RFS) and overall survival (OS) after oncology surgeries. Methods: PubMed, Cochrane library, and Embase were searched from inception to June 20, 2022 for RCTs in which any form of RA was initiated perioperatively. Time-to-event data (hazard ratio (HR)) were extracted independently and in duplicate. The primary outcome was the association of RA with RFS and OS, while the secondary outcomes included time to tumor progression, 5-year RFS, and 5-year OS. Results: Fifteen RCTs with 5981 participants were included. Compared to GA, RA has no positive effect on RFS (HR, − 0.02; 95% CI, − 0.11 to 0.07), OS (HR, − 0.03; 95% CI, − 0.28 to 0.23), time to tumor progression (0.11; 95% CI, − 0.33 to 0.55), 5-year RFS (risk ratio (RR), 1.24; 95% CI, 0.88 to 1.76)), and 5-year OS (RR, 1.11; 95% CI, 0.85 to 1.44). Subgroup analysis based on study design, patient characteristics and tumor types also showed no effect of RA on RFS or OS. Conclusions: Our results demonstrated that there is no significant evidence supporting the role of RA in improving long-term survival after oncology surgeries.