Yuri Koumpan1, Melanie Jaeger2, Glenio Bitencourt Mizubuti1, Rob Tanzola1, Kunal Jain3, Gregory Hosier3, Wilma Hopman4, D Robert Siemens5. 1. Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital Research Institute, Kingston, Ontario, Canada. 2. Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital Research Institute, Kingston, Ontario, Canada. Electronic address: jaegerm@kgh.kari.net. 3. Department of Urology, Kingston General Hospital Research Institute, Kingston, Ontario, Canada. 4. Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada. 5. Department of Urology, Kingston General Hospital Research Institute, Kingston, Ontario, Canada; Department of Oncology, Queen's University, Kingston, Ontario, Canada.
Abstract
PURPOSE: We sought to determine whether anesthetic type (general vs spinal) would influence cancer recurrence following transurethral resection of bladder tumors. MATERIALS AND METHODS: With institutional ethics board approval we examined the electronic medical records of all patients who underwent transurethral bladder tumor resection for nonmuscle invasive urothelial bladder cancer between 2011 and 2013 at a single tertiary care center. Followup information was gathered on all patients in December 2016. The time to first cancer recurrence and the incidence of cancer recurrence were the main outcome measures. RESULTS: A total of 231 patients underwent 1 or more transurethral bladder tumor resections between 2011 and 2013. Of the 231 patients 135 received spinal anesthesia and 96 received general anesthesia. On univariable analysis the 135 patients who received spinal anesthesia had a longer median time to recurrence than the 96 who received general anesthesia (42.1 vs 17.2 months, p = 0.014). As anticipated, adjuvant therapies and risk category were associated with recurrence rates (p = 0.003 and 0.042, respectively). On multivariable analyses incorporating a priori variables of nonmuscle invasive bladder cancer risk stratification and postoperative therapies the patients who received general anesthesia had a higher incidence of recurrence (OR 2.06, 95% CI 1.14-3.74, p = 0.017) and an earlier time to recurrence (HR 1.57, 95% CI 1.13-2.19, p = 0.008) than those who received spinal anesthesia. Anesthetic type was not associated with cancer progression or overall mortality. CONCLUSIONS: Patients who received spinal anesthesia had a lower incidence of recurrence and a delayed time to recurrence following transurethral bladder tumor resection for nonmuscle invasive bladder cancer. These findings should prompt large-scale prospective studies to confirm this association.
PURPOSE: We sought to determine whether anesthetic type (general vs spinal) would influence cancer recurrence following transurethral resection of bladder tumors. MATERIALS AND METHODS: With institutional ethics board approval we examined the electronic medical records of all patients who underwent transurethral bladder tumor resection for nonmuscle invasive urothelial bladder cancer between 2011 and 2013 at a single tertiary care center. Followup information was gathered on all patients in December 2016. The time to first cancer recurrence and the incidence of cancer recurrence were the main outcome measures. RESULTS: A total of 231 patients underwent 1 or more transurethral bladder tumor resections between 2011 and 2013. Of the 231 patients 135 received spinal anesthesia and 96 received general anesthesia. On univariable analysis the 135 patients who received spinal anesthesia had a longer median time to recurrence than the 96 who received general anesthesia (42.1 vs 17.2 months, p = 0.014). As anticipated, adjuvant therapies and risk category were associated with recurrence rates (p = 0.003 and 0.042, respectively). On multivariable analyses incorporating a priori variables of nonmuscle invasive bladder cancer risk stratification and postoperative therapies the patients who received general anesthesia had a higher incidence of recurrence (OR 2.06, 95% CI 1.14-3.74, p = 0.017) and an earlier time to recurrence (HR 1.57, 95% CI 1.13-2.19, p = 0.008) than those who received spinal anesthesia. Anesthetic type was not associated with cancer progression or overall mortality. CONCLUSIONS:Patients who received spinal anesthesia had a lower incidence of recurrence and a delayed time to recurrence following transurethral bladder tumor resection for nonmuscle invasive bladder cancer. These findings should prompt large-scale prospective studies to confirm this association.
Authors: Brady L Miller; E Jason Abel; Glenn Allen; Jessica R Schumacher; David Jarrard; Tracy Downs; Kyle A Richards Journal: Am J Clin Exp Urol Date: 2020-02-25
Authors: Sang Won Lee; Bum Sik Tae; Yoon Ji Choi; Sang Min Yoon; Yoon Sook Lee; Jae Hwan Kim; Hye Won Shin; Jae Young Park; Jae Hyun Bae Journal: J Clin Med Date: 2022-02-21 Impact factor: 4.241