Anesthesia type and lung cancer recurrence after curative surgery

Recurrence Free Survival After Curative Resection of Non-small Cell Lung Cancer Between Inhalational Gas Anesthesia and Propofol-based Total IntraVenous Anesthesia: a Multicenter, Randomized, Clinical Trial

This trial will test whether using propofol-based total intravenous anesthesia (TIVA) instead of inhaled volatile anesthetics lowers the chance of cancer coming back after curative lung surgery in adults with non-small cell lung cancer.

Quick facts

• Phase: PHASE4
• Study type: Interventional
• Enrollment: 5384 (estimated)
• Ages: 19 Years and up
• Sex: All
• Sponsor: Samsung Medical Center (other)
• Locations: 1 site (Seoul, Seoul-teukbyeolsi)
• Trial ID: NCT06330038 on ClinicalTrials.gov

What this trial studies

This double-blind, randomized, multicenter trial assigns adults undergoing curative-intent lung resection for non-small cell lung cancer 1:1 to receive either propofol-based total intravenous anesthesia (TIVA) or volatile inhaled anesthetics. Enrollment is planned across 22 international sites with centralized web-based randomization and data capture, and standard perioperative care is otherwise left to treating teams. The primary outcome is recurrence-free survival after surgery, with longitudinal follow-up for cancer recurrence. The trial is pragmatic and does not standardize perioperative management beyond the randomized anesthesia strategy.

Who should consider this trial

Good fit: Adults with non-small cell lung cancer (clinical stage I–IIIa) scheduled for curative lung resection who are ASA I–III and ECOG 0–2 are the intended participants.

Not a fit: Patients with distant metastases or other active non-remission malignancies, severe organ failure, recent major surgery, or contraindications to the study anesthetics are unlikely to benefit from this intervention.

Why it matters

Potential benefit: If successful, choosing TIVA could reduce cancer recurrence and improve recurrence-free survival after curative lung cancer surgery.

How similar studies have performed: Preclinical studies and retrospective clinical analyses suggest propofol may better preserve anti-tumor immunity than volatile agents, but randomized clinical evidence is inconsistent and definitive large trials are lacking.

Eligibility criteria

Inclusion Criteria:

* American Society of Anesthesiologists physical status (ASA) Ⅰ-Ⅲ
* The Eastern Cooperative Oncology Group (ECOG) performance status 0-2
* Lung resection surgery (segmentectomy, lobectomy, bilobectomy, pneumonectomy; video-assisted, robot-assisted, or open) with curative intent for NSCLC (clinical Tumor, Node, Metastasis (TNM) stage Ⅰ- ⅢA).

Exclusion Criteria:

* Distant metastasis or malignant tumor in other organs that according to the attending surgeon is not in long-term remission
* Severe neurologic conditions
* Severe hepatic disease (Child-Pugh classification C)
* Renal failure requiring renal replacement therapy
* History of anesthesia and/or surgery within 1 yr
* Previous surgery due to lung cancer (except diagnostic biopsies)
* Contraindications to any study medication (history of allergy, hypersensitivity reaction, or any other contraindication)
* Planned joint extrapulmonary procedure
* Surgery under cardiopulmonary bypass or extracorporeal membrane oxygenation
* Postoperative sedation
* Pregnancy, or lactation
* Patient refusal.

Where this trial is running

Seoul, Seoul-teukbyeolsi

• Samsung Medical Center — Seoul, Seoul-teukbyeolsi, South Korea (RECRUITING)

Study contacts

• Principal investigator: Hyun Joo Ahn — Department of Anesthesiology and Pain Medicine, Samsung Medical Center
• Study coordinator: Jeayoun Kim, MD

Conditions: Non-small Cell Lung Cancer, Surgery, Anesthesia, Desflurane, Inhalational anesthesia, Isoflurane, Lung neoplasm, Metastasis