A Narrative Review of Regional vs. General Anesthesia in Cancer Surgery: Immune Pathways and Long-Term Oncologic Outcomes.

The choice between general anesthesia (GA) and regional anesthesia (RA) for oncologic surgery has been widely debated because of the implications for perioperative safety, patient comfort, cancer recurrence, and long-term survival. RA may attenuate surgical stress and preserve immune function, whereas GA, particularly with volatile agents and opioids, may impair immune surveillance. Clinical findings, however, remain inconsistent. The most consistent signals of benefit have been observed in non-muscle-invasive bladder cancer undergoing transurethral resection of bladder tumors (TURBT), where observational cohorts and limited randomized data suggest reduced recurrence with neuraxial techniques. In contrast, studies in colorectal and lung cancer have shown no significant differences in recurrence or survival. Variability in tumor biology, perioperative care, and anesthetic exposure likely contributes to these discrepancies. This narrative review synthesizes randomized trials and large cohort studies to identify tumor types most likely to respond to anesthetic modulation and to highlight important evidence gaps. Overall, any oncologic effect of anesthetic technique appears modest and tumor-specific, warranting further adequately powered, disease-focused trials.