Koumpan Y, et al. - This research was designed to ascertain whether anesthetic type (general vs spinal) would influence cancer recurrence following transurethral resections of bladder tumors. A lower incidence of recurrence and delayed time to recurrence following transurethral bladder tumor resection for non-muscle invasive bladder cancer was observed in patients receiving spinal anesthesia. To confirm this association, these findings ought to prompt large-scale, prospective studies.

Methods

• The physicians examined electronic medical records of all patients who underwent a transurethral bladder tumor resection for non-muscle invasive urothelial bladder cancer between 2011-2013 at a single tertiary care centre, with institutional ethics board approval.
• In December 2016, they gathered follow-up information from all patient.
• The main outcome measures were the time to first cancer recurrence and incidence of cancer recurrence.

Results

• From 2011-2013, 231 patients underwent transurethral bladder tumor resection(s) (135 had a spinal anesthetic and 96 patients had general anesthesia).
• Compared to those who received general anesthesia, patients who received spinal anesthesia had a longer median time to recurrence (42.1 months vs 17.2 months, p=0.014) in univariable analysis.
• Adjuvant therapies (p=0.003) and risk category (p=0.042) were correlated with recurrence rates, as expected.
• Patients under general anesthesia had a higher incidence of recurrence (OR=2.06, 95% CI=1.14-3.74, p=0.017) and earlier time to recurrence (HR=1.57, 95% CI=1.13-2.19, p=0.008) compared to those under a spinal, in multivariable analyses incorporating a priori variables of non-muscle invasive bladder cancer risk stratification and postoperative therapies.
• No association was observed between anesthetic type and cancer progression or overall mortality.