TIP5. Volatile or IV Anesthesia for Cancer – A Randomized Clinical Trial Investigating the Impact of General Anesthesia on Patients with Colon and Rectal Adenocarcinoma

Friday, March 6, 2026

3:47 PM - 3:51 PM MST

Location: Pan-Tumor HUB Zone

Co-Author(s)

Aubrey C. Swilling, DO, MS

Resident Physician
Department of Surgery, University of Kansas Medical Center
Kansas City, Missouri, United States
KE

Kenda Eberhardt, MA

Senior Clinical Research Coordinator
University of Kansas Cancer Center
Kansas City, Kansas, United States
BM

Benjamin M. Martin, MD FACS FACRS

Assistant Professor of Surgery
Department of Surgery, University of Kansas Medical Center
Kansas City, Kansas, United States
MA

Mazin Al-Kasspooles, MD

Professor of Surgery
Department of Surgery, University of Kansas Medical Center
Kansas City, Kansas, United States
JA

John H. Ashcraft, DO FACS FASCRS

Associate Professor of Surgery
Department of Surgery, University of Kansas Medical Center
Kansas City, Kansas, United States
SL

Sam Luka, MD FACS FASCRS

Assistant Professor of Surgery
Department of Surgery, University of Kansas Medical Center
Kansas City, Kansas, United States
AK

Anup Kasi, MD MPH

Associate Professor of Medicine
Department of Medicine, Division of Medical Oncology, University of Kansas Medical Center
Kansas City, Kansas, United States
BR

Badal Roy, PhD

Senior Scientist
Department of Surgery, University of Kansas Medical Center
Kansas City, Kansas, United States
NS

Nadine Santana-Magal, PhD

University of Kansas Medical Center
Kansas City, Kansas, United States
DD

Debolina Dasgupta, MS

Graduate Student
Department of Cancer Biology, University of Kansas Medical Center
Kansas City, Kansas, United States
DF

Debbie Fernandez, LMLP, MHSA, CPHQ

Director of quality, Oncology Service Line
University of Kansas Cancer Center
Kansas City, Kansas, United States
MH

Marc S. Hoffmann, MD

Associate Professor of Medicine
Department of Medicine, Division of Medical Oncology, University of Kansas Medical Center
Kansas City, Kansas, United States
LB

Lexie Brown, PhD

Assistant Research Professor
Department of Biostatistics, University of Kansas Medical Center
Kansas City, Kansas, United States
KP

Kalyani Pyaram, PhD

Assistant Professor
Department of Cancer Biology, University of Kansas Medical Center
Kansas City, Kansas, United States
SU

Shahid Umar, PhD

Professor of Surgery
Department of Surgery, University of Kansas Medical Center
Kansas City, Kansas, United States
EP

Erin Plaza, MD

Associate Professor of Anesthesiology
Department of Anesthesiology, University of Kansas Medical Center
Kansas City, Kansas, United States

Primary Presenter(s)

Luke V. Selby, MD MS FACS FSSO

Assistant Professor of Surgery
University of Kansas Medical Center
Leawood, Kansas, United States

Slides

Introduction

Surgery is required for cure of most solid tumors, and general anesthesia is often required for most surgery. General anesthesia can be delivered through two broad approaches: volatile inhalational anesthesia (IA) or propofol-based total intravenous anesthesia (TIVA). Of these, IA is the most common, but is associated with worse post-operative recovery, post-operative immune dysregulation, earlier cancer recurrence, and worse overall survival. Multiple randomized controlled trials have demonstrated that TIVA improves short-term post-operative recovery, but few of these studies have included translational outcomes. In vitro, propofol is known to inhibit the formation of neutrophil extracellular traps (NETs) that increase post-operatively and are associated with tumor recurrence. In spite of a biologic rationale for improved cancer outcomes, and studies showing improved clinical outcomes, it is estimated that TIVA is used in less than 10% of eligible cases nationally. Some opposition to TIVA is that it is believed to be more difficult to administer, but to our knowledge this has never been comprehensively evaluated.

Methods

The VIVA trial (NCT06017141) is a prospective randomized trial in patients with primary resectable colon or upper rectal adenocarcinoma. Following exclusions for preexisting autoimmune conditions or a personal or family history of malignant hyperthermia, patients (n=80) with non-metastatic colon or upper rectal adenocarcinoma receiving upfront surgery are randomized 1:1 to TIVA or IA. Immune dysregulation is measured by changes in NET formation (the primary outcome) and changes in immune cell populations using flow cytometry. Differential RNA and protein expression are measured in resected tumor and adjacent normal colon. Clinical recovery from surgery is measured broadly, including with patient reported outcome measures (the Quality of Recovery-40 and the Saint Louis Mental Status Exam), post-operative nausea and vomiting, opioid use, pain scores, and length of stay. In a subset of cases, anesthesia delivery will be directly observed to compare the required interventions while delivering TIVA and IA and then correlated with EHR-recorded anesthetic dose adjustments for the full cohort to assess the relative difficulty of delivering TIVA vs IA. The VIVA trial (NCT06017141) has finished patient enrollment. It is anticipated the final patients will undergo surgery in October 2025 with primary data collection and patient unblinding occurring six months post-operatively.

Results

Results are pending completion of primary data collection and patient unblinding, anticipated six months after the final surgical case in October 2025.

Conclusions

Final analyses will evaluate whether TIVA reduces perioperative immune dysregulation and improves clinical recovery compared to IA, as well as assess the relative feasibility of administering TIVA in routine oncologic surgery.

Learning Objectives:

Describe the proposed benefits of total intravenous anesthesia (TIVA) as compared to volatile inhalation anesthesia (IA).
Describe the hypothesized barriers to wider use of total intravenous anesthesia (TIVA).