Potential influence of anaesthesia techniques on the recurrence and progression after resection of non-muscle-invasive bladder cancer: a propensity score-matched analysis

Abstract

Background The non-muscle-invasive bladder cancer is a common malignancy of the urinary system. Many patients relapse after transurethral resection surgery. Different anaesthesia techniques may influence a patient’s immune system during the perioperative time. In this study, we examined the effects of different anaesthesia techniques on the prognosis of primary non-muscle-invasive bladder cancer after transurethral resection surgery. Methods In the period 2008 to 2017, a total of 926 patients suffered primary non-muscle-invasive bladder and underwent transurethral resection of bladder tumour surgery for the first time. These patients were divided into two groups according to the techniques that were used. There were 662 patients in the general anaesthesia group, who received propofol, opioid drugs (fentanyl family), non-depolarizing muscle relaxants, and sevoflurane, and 264 patients in the epidural anaesthesia group, who had an epidural catheter placed in the L2-L3 or L3-L4 interspace with a combination of lidocaine and ropivacaine or bupivacaine. We analyzed the influence factors that might affect prognosis and compared the recurrence-free survival time and the progression between the two groups. Results The differences between the two groups in recurrence rate and progression rate were not statistically significant. Progression-free survival time of the epidural anaesthesia group was longer. Multivariate regression analysis showed that anaesthesia techniques were not independent influencing factors for recurrence and progression. Conclusions It was not found that anaesthesia techniques affected the recurrence or progression of patients with primary non-muscle-invasive bladder cancer after transurethral resection of bladder tumour.

Effect of regional versus general anesthesia on recurrence of non-muscle invasive bladder cancer: a systematic review and meta-analysis

“…Two literatures, comprising 300 subjects, compared cancer progression between two groups [14,16]. No signi cant association was found between RA or GA and the progression of NMIBC (RR = 1.14, 95%CI = 0.71-1.84, P = 0.589,Fig.…”

“…When subgroup analyses [14][15][16][17][18]20] were performed based on the speci c types of RA [14][15][16][17][18]20], we found that spinal anesthesia signi cantly reduced the recurrence of NMIBC (RR = 0.80, 95%CI = 0.72-0.88, P < 0.001, Supplemental Fig. 1).…”

“…Recently, there have been many studies [14][15][16][17][18][19][20][21] exploring the association between anesthesia methods and recurrence of the NMIBC after TRUBT. However, the inconsistent conclusions and limited subjects of these literatures reduce their credibility of the evidence.…”

“…All the eligible studies in our meta-analysis were wellrepresented and exposed. Three studies [14,15,17] were propensity matched, and the comparability was good. However, four studies [16, 18-20] have signi cant differences in the age of patients receiving RA and GA, which may induce confounding bias and thus score poorly on comparability.…”

“…[13], and some recent studies supported this conclusion. [14,15]. However, some researchers have linked the use of spinal anesthesia to a lower rate of recurrence of NMIBC [16][17][18].…”