What question did this study set out to answer?

The study aims to evaluate the effects of CIVA versus TIVA on mortality in cancer surgery patients.

February 14, 2026Frontiers in Medicine0 citationsOpen Access

Comparison of total intravenous anesthesia and combined inhalation and intravenous anesthesia on survival after tumor surgery: a propensity score matched cohort study

YWYue WangUniversity of Stuttgart XWXi WuWuhan Union Hospital SPShuaijie PeiTianjin Medical University General Hospital

Puntos clave

The study aims to evaluate the effects of CIVA versus TIVA on mortality in cancer surgery patients.
Conducted a retrospective cohort study at a tertiary care hospital in China.
Analyzed data from 25,351 patients undergoing cancer surgery from 2014 to 2018.
Utilized propensity score matching to adjust for confounding variables and employed Cox regression models for analysis.
CIVA was associated with increased long-term mortality but not with short-term mortality.
In the 1:3 matched cohort, CIVA showed a hazard ratio of 1.220 for 3-year mortality, indicating an increased risk.
Among the matched cohort, 4,519 received TIVA versus 1,536 who received CIVA.

Resumen

Background Prior studies have indicated that inhalation anesthesia in cancer surgery might heighten the risk of tumor metastasis and diminish patient survival. Yet, combined inhalation and intravenous anesthesia (CIVA), a prevalent general anesthesia technique, remains underexplored regarding its influence on postoperative survival in cancer surgery patients. To fill this gap, this study compares the short-term and long-term mortality of cancer surgery patients receiving CIVA versus total intravenous anesthesia (TIVA). Methods A retrospective cohort study was conducted at a tertiary care hospital in China, comprising 25,351 patients who underwent cancer surgery under general anesthesia between January 2014 and December 2018. The primary outcomes were short-term mortality (within 3 months) and long-term mortality (within 3 years). CIVA and TIVA were the primary exposures. Propensity score matching (PSM) was employed to adjust for confounding factors, and Cox regression models were utilized to estimate hazard ratios (HR) and 95% confidence intervals (CIs) for mortality outcomes. Results Among the 25,351 patients who underwent tumor resection, 23,790 were administered TIVA, while 1,561 received CIVA. In the 1:3 PSM cohort, 1,536 patients received CIVA, and 4,519 patients received TIVA. The Cox regression models for the 1:1, 1:2, and 1:3 PSM cohorts indicated that CIVA was associated with long-term mortality but not with short-term mortality. The multivariable Cox regression model following 1:3 PSM revealed that CIVA was associated with an increased risk of 3-year mortality (HR: 1.220; 95% CI: 1.043–1.404). Conclusion Our results provided indirect evidence of potential hazard of inhaled anesthetics, even as a compound in CIVA, on long-term mortality after cancer surgery. Given the limitations of this retrospective study, further prospective work exploring the effect of anesthetic technique on mortality is urgently needed.

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