CUA 2018: Spinal Anesthesia is Associated with Lower Recurrence Rates after Resection of Non-Muscle-Invasive Bladder Cancer

Halifax, Nova Scotia (UroToday.com)  There has been some published evidence that spinal anaesthesia (SA) may improve oncological outcomes by minimizing use of volatile anesthetics and opioids, which could potentially increase immunosuppression and promote tumor seeding, when compared to general anaesthesia (GA). 



In this presented retrospective observational study, the authors aimed to assess whether different anesthetic types could influence cancer recurrence following a transurethral resection of bladder tumours (TURBT). 

A total of 231 patients undergoing TURBT for non-muscle-invasive bladder cancer (NMIBC) were analyzed at a single centre between 1996 and 2014 (Table 1). The results demonstrated that in univariable analysis, patients under SA (n=135) had a longer median time to recurrence (42.1 vs. 17.2 months; p=0.014) compared to those who had GA (n=96) (Figure 1). The authors also performed multivariable analyses, incorporating a priori variables, including cancer risk (stage, grade, presence of carcinoma in situ, number and size of tumours), perioperative chemotherapy, and adjuvant immunotherapy. It was clearly demonstrated that patients under GA had a higher incidence of recurrence (odds ratio 2.062; 95% confidence interval [CI] 1.14–3.74; p=0.017) and earlier time to recurrence (hazard ratio 1.57; 95% CI 1.13–2.1; p=0.008) compared to patients under SA. However, anesthetic type was not associated with cancer progression or overall mortality. 

In this interesting observational study, the authors concluded that patients receiving a GA had higher incidence of recurrence and earlier time to recurrence following TURBT for NMIBC compared to patients undergoing the same procedure under SA. A prospective randomized trial should be considered to further validate this interesting finding.  

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Presented By: Hosier Gregory W., Queen's University, Kingston, Canada 

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, Twitter: @GoldbergHanan  at the 73rd Canadian Urological Association Annual Meeting - June 23 - 26, 2018 - Halifax, Nova Scotia
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