Impact of type of anaesthesia on long-term outcomes in glioma patients undergoing craniotomy: A systematic review

Abstract

Objective: To assess the effects of volatile and intravenous anaesthetic agents on long-term outcomes in patients with glioma, undergoing tumour resection.

Methodology: This systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Two databases were searched from inception until January 2025, namely PubMed/MEDLINE and EMBASE using MeSH terms for anaesthesia and glioma. Six retrospective cohort studies were selected for data extraction after thoroughly reviewing the database search results against pre-determined inclusion and exclusion criteria. The quality assessment was done as per National Heart, Lung and Blood institute checklist for observational studies.

Results: A total of six retrospective cohort studies conducted between 2017 and 2021 were reviewed. These included both sexes, predominantly aged over 18 years, except for one study that enrolled patients as young as 16. Five studies concluded that the type of anaesthesia had no effect on survival or recurrence. Only one associated propofol with increased progression free survival (PFS) and overall survival (OS). While rest of the studies showed no effect, Dong et al. suggested that sevoflurane may reduce OS in patients with Karnofsky Performance Status (KPS) <80. Overall, the type of general anaesthesia drugs did not affect five-year PFS rate.

Conclusion: We found no impact of anaesthetic agent on glioma outcomes in majority of studies, but the literature suggesting potential tumour-modulating effects of these drugs is significant enough to warrant further studies. Similar associations exist in other cancers. Well-designed RCTs are crucial to clarify if anaesthetic agents affect long-term survival and oncological outcomes in glioma patients.