Anesthesia Type during Cancer Surgery: Results of the GA-CARES Randomized, Multicenter Trial.

Area of Science:

• Anesthesiology
• Surgical Oncology
• Immunology

Background:

• Surgical resection is a common cancer treatment.
• Anesthesia choice may impact cancer recurrence via immune response and cell seeding.
• Limited large randomized trials exist on propofol vs. volatile agents in cancer surgery.

Purpose of the Study:

• To compare propofol-based anesthesia with volatile agents for cancer resection outcomes.
• To investigate the effect of anesthetic choice on cell-mediated immunity and tumor cell implantation.
• To evaluate cancer-related outcomes in patients receiving different general anesthetics.

Main Methods:

• The GA-CARES trial was a multicenter, randomized superiority trial.
• Adults undergoing resection for high-risk cancers were randomized to propofol or volatile agent anesthesia.
• The primary endpoint was all-cause mortality at minimum 2-year follow-up; secondary endpoint was disease-free survival.

Main Results:

• High adherence (95.9%) to assigned anesthetic was observed.
• Propofol did not improve survival in the intent-to-treat population (HR 1.16, P=0.115).
• Propofol was associated with significantly higher mortality in the per-protocol population (HR 1.31, P=0.017).

Conclusions:

• Propofol-based anesthesia did not improve cancer-related outcomes.
• The study did not support the hypothesis that propofol is superior to volatile agents for cancer resection.
• Further research may be needed to clarify the role of anesthetic agents in cancer surgery.