Table 1 Study characteristics
Study | Design | Tumor | Follow-up | RA (n) | GA (n) | Estimates origin | Outcome | HR (95%Cl) | Other relative outcomes |
|---|---|---|---|---|---|---|---|---|---|
Christopherson 2008 [24] | Multi-center RCT | Colon cancer | 8.3–10.8 years | GA + EDA initiated before surgery and PA until clinical appropriation (85) | GA + opioid PA (92) | Kaplan-Meier curve, log rank test | OS | 0.22 (0.07–0.69) | Non-metastasis and follow-up time less than 1.46 years: RA increased OS Metastasis or beyond 1.46 years: no statistical difference |
Tsui 2010 [19] | Single-center RCT | Prostate cancer | Median 4.5 years | GA + EDA intraoperatively (49) | GA (50) | Kaplan-Meier curve, log rank test | RFS | 1.33 (0.64–2.77) | Median time to recurrence: HR 1.34 (0.65–2.76) Median RFS: 1644 days |
Myles 2011 [25] | Multi-center RCT | Abdominal malignancies | 9.0–14.8 years | GA + EDA initiated before surgery and PA for 74 h (230) | GA + PCIA (216) | Kaplan-Meier curve, log rank test | RFS OS | 0.95 (0.76–1.17) 0.95 (0.77–1.18) | Median time to recurrence: HR 0.63 (0.39-1.02); Median survival time: HR 0.95 (0.77-1.18) 5-year RFS: RR 0.95 (0.78–1.15); 5-year OS: RR 0.96 (0.79-1.17) |
Binczak 2013 [22] | Single-center RCT | Abdominal malignancies | Median 17.3 years | GA + EDA initiated before surgery and PA for 5 days (69) | GA + opioid analgesia (63) | Multivariate Cox model, adjusted HR | RFS OS | 0.81 (0.52–1.26) 0.71 (0.47–1.07) | Median time to recurrence: 3 years vs 1.8 years 5-year RFS: 43% (32–55%) vs 24% (15–36%) 5-year OS: 51% (40–63%) vs 32% (22–44%) |
Finn 2017 [20] | Single-center RCT | Breast cancer | > 2 years | GA + PVB IBS and PA for a multiple-day (26) | GA (28) | Chi-square test | RFS OS | RR 1.62 (0.29–8.91) RR 9.67 (0.55–171.23) | Not reported |
Zhu 2017 [21] | Single-center RCT | Bladder cancer | 3 years | GA + EDA intraoperatively (72) | GA (72) | Kaplan-Meier curve, log rank test | OS | 1.17 (0.71–1.92) | RA increased survival rates of CD3+, CD4+ and CD4+/CD8+ cells during postoperative 3 days Survival rate: 1 years: 80.56% vs 83.33%; 2 years: 68.06% vs 72.22%; 3 years: 54.17% vs 59.72% |
Karmakar 2017 [23] | Single-center RCT | Breast cancer | 5 years | GA + single PVB (57) | GA (60) | Kaplan-Meier curve, log rank test | RFS OS | 0.66 (0.11–3.97) 2.57 (0.66–9.92) | There was no difference in the risk of local cancer recurrence, metastasis or all-cause mortality between the groups (p = 0.79, p = 0.91, and p = 0.13) |
GA + PVB initiated before surgery and PA for 72 h (60) | RFS OS | 0.79 (0.21–2.96) 1.11 (0.32–3.83) | |||||||
Sessler 2019 [26] | Multi-center RCT | Breast cancer | Median 3 years | Propofol + PVB intraoperatively (1043) | Sevoflurane + opioid (1065) | Multivariate Cox model, adjusted HR | RFS | 0·97 (0·74–1·28) | Median time to recurrence: 15 vs 17 months Sensitivity analysis: China HR 0·77 (0·55–1·09) Asian ethnic origin: HR 0·78 (0.56–1.10) |
Pi 2019 [29] | Single-center RCT | Lung cancer | 5 years | GA + EDA intraoperatively (74) | GA (75) | Chi-square test | RFS OS | RR 1.04 (0.77–1.41) RR 1.55 (0.88–2.74) | IL-1, IL-8, hs-CRP, TNF-a, and MDA were lower in GA+EDA group (P<0.05), 5 year RFS: RR 1.04 (0.77–1.41); 5-year OS: RR 1.55 (0.88–2.74) |
MacFater 2020 [30] | Single-center RCT | Colon cancer | 8.5–9.5 years | GA + local anesthetic infusion before surgery and PA for 72 h (18) | GA (19) | Kaplan-Meier curve, log rank test | RFS OS | 3.63 (0.63–20.94) 1.46 (0.53–4.03) | There was a significantly increased difference in cancer specific mortality in RA group (4) compared with the GA group (0) (P = 0.046). |
Rangel 2021 [27] | Single-center RCT | Prostate cancer | Median 1 year | GA without opioid + TAP intraoperatively (72) | GA with opioid (71) | Kaplan-Meier curve, log rank test | Biochemical RFS | 1.25 (0.62–2.52) | Time to biochemical recurrence: HR 2.82 (0.07-1.92) |
Falk 2021 [28] | Multi-center RCT | Colorectal cancer | 5 years | GA + EDA initiated before surgery and PA for 72 h (99) | GA + opioid analgesia (104) | Multivariate Cox model, adjusted HR | RFS | 1.19 (0.61–2.31) | 5-year RFS:1.19 (0.61–2.31), sensitivity analyses showed similar or somewhat lower HR, ranging from HR 1.09 to HR 1.14 |
Du 2021 [31] | Multi-center RCT | Abdominal malignancies | Median 5.5 years | GA + EDA initiated before surgery and PA (853) | GA + opioid analgesia (859) | Multivariate Cox model, adjusted HR | RFS OS | 0.97 (0.84–1.11) 1.06 (0.91–1.24) | Cancer-specific survival: HR, 1.09 (0.93 to 1.28) Event-free survival: HR, 0.98 (0.86 to 1.12) |
Xu 2021 [32] | Single-center RCT | Lung cancer | Median 3 years | GA + EDA initiated before surgery and PA for 72 h (200) | GA (200) | Multivariate Cox model, adjusted HR | RFS OS | 0.90 (0.60–1.35) 1.12 (0.64–1.96) | Cancer-specific survival: HR, 1.08 (0.61–1.91) |
Li 2022 [33] | “Sessler 2019” (subgroup) | The same as Sessler 2019 | Median 4.4 years | The same as Sessler 2019 (624) | The same as Sessler (629) | Multivariate Cox model, adjusted HR | RFS | 0.92 (0.67–1.26) | Estrogen receptor negative: HR, 0.80 (0.50–1.30) Estrogen receptor positive: HR, 1.06 (0.71–1.60) |