Evaluating Intravenous Albumin Usage in Surgical Oncology: A Systematic Review and Meta-Analysis

Background: Intravenous (IV) albumin is commonly used in perioperative care, yet its role in surgical oncology remains unclear. Despite its higher cost and associated risks compared to crystalloids, albumin usage varies significantly in oncology surgery, and no clear clinical guidelines exist. Prior studies in other surgical fields have shown no significant benefit of albumin over crystalloids in patient outcomes, raising questions about its efficacy and necessity in oncology surgery. Objective: This systematic review and meta-analysis aims to evaluate whether IV albumin administration improves patient outcomes in surgical oncology procedures compared to alternative strategies, such as crystalloids. Methods: Following Cochrane and PRISMA guidelines, a comprehensive literature search will be conducted across EMBASE, MEDLINE and Cochrane databases. Eligible studies will include randomized controlled trials (RCTs) comparing IV albumin to alternative fluid strategies in oncology surgery procedures. A panel of experts will rank reported outcomes based on clinical importance, with only those deemed important and critical to decision-making included. All references identified through databases will be screened independently and in duplicate in Covidence. Data extraction and risk of bias assessment will be performed independently and in duplicate. Meta-analysis will employ a random-effects model, with statistical heterogeneity assessed using the I² statistic. Certainty of evidence will be evaluated using the GRADE approach. Preliminary Results: A manual search identified four relevant studies examining albumin use in pancreatectomy, upper gastrointestinal cancer surgery, bladder cancer cystectomy, and colorectal cancer tumor resection. All studies found no improvement in postoperative outcomes with albumin administration compared to crystalloids or no albumin. Conclusion: This review will provide critical insights into the clinical effectiveness of IV albumin in surgical oncology, helping to inform evidence-based perioperative care guidelines and optimize healthcare resource allocation.