The Impact of Total Intravenous Anesthesia and Volatile Anesthetics on Minimizing Cancer Recurrence and Postoperative Cognition.

As the incidence of cancer and the number of annual oncologic surgeries continue to rise, especially among younger populations, there is increasing interest in how perioperative factors, including the choice of anesthetic agent, may influence long-term oncologic survival outcomes and postoperative cognitive recovery. While surgery remains a mainstay component of treatment for solid organ malignancies, the physiological stress and inflammatory response triggered during the perioperative period may play a meaningful role in tumor progression, recurrence, and metastasis. Given these concerns and the potential benefit of selective anesthesia, the choice of anesthetic agent has gained increased attention for its potential to impact patient care, recovery, and outcomes beyond perioperative management, including postoperative delirium (POD) and postoperative cognitive dysfunction (POCD). In addition to providing adequate intraoperative sedation, propofol-based total intravenous anesthesia (TIVA) and inhaled volatile agents have been studied with the intent of characterizing their oncologic impact, which has yielded mixed results, making it difficult to conclude that one agent is superior to the other. Limitations in trial design, cancer heterogeneity, and confounding perioperative factors, such as agent administration timing and adjunctive sedation, underscore the need for larger-scale, multicenter randomized trials with long-term follow-up periods to better characterize the impact of anesthetic agents. Until more definitive evidence emerges, anesthetic choice should be individualized based on individual comorbidities, cognitive risk factors, surgical context, and anesthesiologist familiarity.