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

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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.

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Acknowledgements

We are grateful to Medical English Service (https://www.med-english.com/) for the English language review.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Urology, Keio University School of Medicine, 35 Shinanomachi, , Shinjuku, Tokyo, 160-8582, Japan

    Yuto Baba, Eiji Kikuchi, Keisuke Shigeta, Koichiro Ogihara, Yui Nishimoto, Yasuaki Murata, Ryuichi Mizuno & Mototsugu Oya

  2. Department of Urology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan

    Eiji Kikuchi

  3. Department of Urology, Ogikubo Hospital, 3-1-24 Imagawa, Suginami, Tokyo, 167-0035, Japan

    Masashi Matsushima

  4. Department of Urology, Saitama Medical University Hospital, 38 Morohongo Moroyama-machi, Iruma-gun, Saitama, 350-0495, Japan

    Hirotaka Asakura

  5. Department of Uro-Oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan

    Masafumi Oyama

Authors
  1. Yuto Baba
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  2. Eiji Kikuchi
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  3. Keisuke Shigeta
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  4. Koichiro Ogihara
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  5. Masashi Matsushima
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  8. Hirotaka Asakura
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  9. Masafumi Oyama
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  10. Ryuichi Mizuno
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  11. Mototsugu Oya
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Contributions

Conceptualization and methodology YB, EK, KS. Formal analysis and investigation, original draft preparation YB, YN, YM. Review and editing EK, KS. Resources KO, MM, YN, YM. Supervision HA, MO, RM, MO.

Corresponding author

Correspondence to Eiji Kikuchi.

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Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The institutional review board in each facility regarding this study has approved the study.

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Informed consent was obtained from all individual participants included in the study.

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Cite this article

Baba, Y., Kikuchi, E., Shigeta, K. et al. Effects of transurethral resection under general anesthesia on tumor recurrence in non-muscle invasive bladder cancer. Int J Clin Oncol 26, 2094–2103 (2021). https://doi.org/10.1007/s10147-021-02000-z

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  • DOI: https://doi.org/10.1007/s10147-021-02000-z

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