Authors: Kabbara J et al.
Cureus, June 19, 2026.
Summary
This narrative review examined whether regional anesthesia, compared with general anesthesia, affects cancer recurrence, metastasis, or long-term survival after oncologic surgery.
Surgery produces a substantial neuroendocrine and inflammatory stress response. Increased catecholamines, cortisol, inflammatory cytokines, and perioperative immunosuppression may reduce natural killer-cell activity and allow circulating tumor cells or microscopic residual disease to survive. Volatile anesthetics and opioids may further impair immune surveillance, while regional anesthesia may attenuate the surgical stress response, reduce opioid exposure, preserve natural killer-cell activity, and decrease proangiogenic signaling.
Although these mechanisms provide a strong biological rationale for regional anesthesia, the clinical evidence remains inconsistent.
The strongest potential benefit was found in non-muscle-invasive bladder cancer. A large meta-analysis involving more than 13,000 patients undergoing transurethral resection of bladder tumors reported a 26% reduction in recurrence when regional anesthesia was added to general anesthesia. However, other bladder cancer studies have found no significant difference between spinal and general anesthesia.
Early retrospective studies in prostate cancer suggested that epidural analgesia might reduce biochemical recurrence after radical prostatectomy. One study reported a 57% reduction in recurrence. More recent analyses controlling for tumor stage and pathology, however, have not consistently confirmed this benefit.
Some retrospective studies involving ovarian and other gynecologic cancers reported longer progression-free and overall survival with epidural analgesia. These findings are limited by possible selection bias, uncontrolled confounding factors, and the absence of large randomized trials.
Regional anesthesia and propofol-based techniques in breast cancer may produce favorable changes in natural killer-cell function, inflammatory markers, and vascular endothelial growth factor levels. Nevertheless, the landmark multicenter randomized trial by Sessler et al. found no significant difference in breast cancer recurrence or survival between paravertebral block with propofol and volatile general anesthesia with opioid analgesia.
Randomized trials in lung cancer similarly found no improvement in recurrence-free or overall survival when epidural anesthesia was added to general anesthesia.
Evidence in colorectal cancer is also inconsistent. Some retrospective studies reported improved survival with epidural analgesia, while large registry studies, systematic reviews, and randomized-trial analyses found no consistent reduction in recurrence or mortality.
The authors emphasized that tumor biology may influence whether anesthetic modulation has any clinically meaningful effect. Immunologically active tumors, such as bladder cancer, may be more responsive to preserved perioperative immune function. Tumors with immune-cold or highly complex microenvironments, such as prostate and colorectal cancers, may be less affected by anesthetic technique.
The review also highlighted important weaknesses in much of the supportive literature, including retrospective study designs, inadequate control of cancer stage and surgical technique, inconsistent definitions of recurrence, lack of blinding, and failure to stratify patients by tumor subtype or immune phenotype.
What You Should Know
Regional anesthesia may reduce the surgical stress response, opioid requirements, inflammation, angiogenic signaling, and perioperative immune suppression.
These biological effects have not consistently translated into improved cancer recurrence or survival outcomes.
The most convincing potential clinical benefit is in non-muscle-invasive bladder cancer, although the evidence is still not definitive.
Large randomized trials in breast and lung cancer have shown no long-term oncologic benefit from regional techniques.
Evidence involving prostate, gynecologic, and colorectal cancers remains mixed and is largely based on retrospective studies.
Anesthetic technique should not currently be selected solely to reduce cancer recurrence. Patient safety, surgical requirements, postoperative pain control, and recovery should remain the primary considerations.
Future research should consist of adequately powered randomized trials focused on specific cancer types, stages, molecular subtypes, and immune characteristics.
Thank you to Cureus for allowing us to summarize this article.