Effects of transurethral resection under general anesthesia on tumor recurrence in non-muscle invasive bladder cancer

Yuto Baba, Eiji Kikuchi, Keisuke Shigeta, Koichiro Ogihara, Masashi Matsushima, Yui Nishimoto, Yasuaki Murata, Hirotaka Asakura, Masafumi Oyama, Ryuichi Mizuno, Mototsugu Oya

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The effects of the type of anesthesia (spinal (SA) vs. general (GA)) used for transurethral resection of bladder tumor (TURBT) on non-muscle invasive bladder cancer (NMIBC) recurrence and progression are controversial and our aim is to investigate their associations. Methods: We identified 300 NMIBC patients who underwent initial TURBT with SA or GA. Cox’s regression analysis was performed to examine the effects of anesthesia on tumor recurrence. Results: Among 300 patients, 153 (51.0%) received GA and 147 (49.0%) SA. The 5-year recurrence-free survival (RFS) rate was 59.9% in the GA group, which was significantly lower than that in the SA group (74.4%, p = 0.029). GA (HR 1.57, p = 0.048), male sex (HR 2.72, p = 0.012), and tumor multiplicity (HR 1.96, p = 0.006) were independently associated with tumor recurrence. In a subgroup of 137 patients with high-risk NMIBC, the 5-year RFS rate was 50.3% in the GA group, which was significantly lower than that in the SA group (77.6%, p = 0.020), and GA remained an independent indicator of tumor recurrence (HR 2.35, p = 0.016). However, no significant differences were observed in the RFS rates of low- to intermediate-risk NMIBC patients between the GA and SA groups. Conclusions: The RFS rate was lower in NMIBC patients who received GA during TURBT than in those who received SA. Volatile anesthesia may increase tumor recurrence, particularly in high-risk NMIBC patients, which may be due to the inhibition of the immune response system during surgery.

Original languageEnglish
Pages (from-to)2094-2103
Number of pages10
JournalInternational Journal of Clinical Oncology
Volume26
Issue number11
DOIs
Publication statusAccepted/In press - 2021

Keywords

  • General anesthesia
  • Non-muscle invasive bladder cancer
  • Spinal anesthesia
  • Transurethral resection of bladder tumor
  • Tumor recurrence

ASJC Scopus subject areas

  • Surgery
  • Hematology
  • Oncology

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