Does anesthesia choice shape oncologic destiny in gastric cancer surgery?

Abstract

Anesthetic management in gastric cancer surgery has progressed from a technical necessity to a potential influencer of perioperative immune function and long-term oncologic outcomes. The perioperative period-marked by inflammation, stress responses, and immunosuppression-is increasingly seen as critical to cancer recurrence risk. This has prompted investigations into whether anesthetic agents could shape oncologic trajectories. The recent study by Wang et al contributes valuable data by comparing sevoflurane inhalation anesthesia and propofol-based total intravenous anesthesia in patients undergoing radical gastrectomy. While no significant differences were observed in survival outcomes, subtle variations in post-operative nausea and intraoperative hemodynamics raise important considerations about anesthetic-specific physiologic effects. This editorial reflects on these findings in the broader context of ongoing efforts to individualize perioperative care in oncology. It also underscores the need for future prospective studies integrating immune, molecular, and clinical endpoints to determine whether anesthetic techniques can play a meaningful role in long-term cancer control. As the field advances, anesthesia should no longer be viewed as a neutral backdrop but as a modifiable component of comprehensive cancer care. Determining when, how, and for whom an anesthetic technique matters remains an open but essential question.

Keywords: Anesthesia; Gastric cancer; Propofol; Sevoflurane; Total intravenous anesthesia

Core Tip: Anesthetic choice in gastric cancer surgery extends beyond technical preference, potentially influencing immune function, stress response, and oncologic outcomes. Propofol-based total intravenous anesthesia demonstrates promising molecular and clinical anti-tumor properties-modulating microRNAs, enhancing natural killer cell activity, and improving post-operative recovery-while sevoflurane, though traditionally considered neutral, shows emerging immunoregulatory and gene-expression effects. Current evidence, including the recent Wang et al’s study, suggests both agents yield comparable perioperative safety and survival outcomes; however, their distinct molecular profiles highlight anesthesia as a modifiable element in personalized cancer care. Future biomarker-driven research is essential to clarify when and how anesthetic selection might influence long-term oncologic prognosis.