Background Intravenous albumin is commonly administered during surgical oncology procedures despite limited evidence of benefit. This systematic review and meta-analysis evaluated whether albumin administration, compared to alternative fluid strategies, improves outcomes in patients undergoing cancer surgery. Methods We searched MEDLINE, EMBASE, and Cochrane databases from inception to March 5, 2025, without language restrictions, following PRISMA and Cochrane guidelines. We included randomized controlled trials (RCTs) comparing albumin with alternative fluid strategies (crystalloids, synthetic colloids, or no albumin) in adult cancer surgery patients. We evaluated outcomes rated as important or critical by an expert panel, performed meta-analyses using random-effects models, and assessed certainty of evidence using GRADE. Results We included nine RCTs (n=890 patients), five of which used crystalloids as the comparator. Pooled analysis found there may be no difference between albumin and alternative fluid groups in total complication rates (risk ratio RR = 0.96; 95% confidence interval CI: 0.68 to 1.35), intensive care unit or hospital length of stay, or perioperative blood loss (all low to moderate certainty). Effects on mortality and inotrope/vasopressor use were uncertain (very low certainty). Albumin administration was probably associated with a lower perioperative fluid balance (mean difference MD = -169.97 mL; 95% CI: -293.41 to -46.52, moderate certainty). Conclusions Current evidence suggests albumin may not improve patient-important outcomes in surgical oncology. The modest reduction in fluid balance observed with albumin is unlikely to be clinically meaningful, and routine albumin use may contribute to unnecessary healthcare costs. Larger, multicentre RCTs are needed to guide evidence-based perioperative fluid management in surgical oncology.
Moses et al. (Fri,) studied this question.