Anesthetic approaches and 2-year recurrence rates in non-muscle invasive bladder cancer: a randomized clinical trial

Clinical Snapshot

Key Findings

• P Value: Statistically significant (exact p-value not provided)

• Effect Size: Absolute risk reduction of 12.8% favoring spinal anesthesia

• Primary Outcome: 2-year NMIBC recurrence rate: 26.8% (SA) vs 39.6% (GA) in modified ITT population

• Nnt Or Sensitivity: Number needed to treat = 8 patients (1/0.128) to prevent one recurrence

• Confidence Interval: Not reported in abstract

Clinical Application

Highly feasible in Australian practice where both anesthetic approaches are routinely available Aligns with RACGP cancer care principles; spinal anesthesia already preferred for many urological procedures in Australian public hospitals due to cost-effectiveness and reduced perioperative complications Patients with NMIBC suitable for TURBT who are candidates for either spinal or general anesthesia

Abstract

BACKGROUND: The effect of anesthesia methods on non-muscle invasive bladder cancer (NMIBC) recurrence post-resection remains uncertain. We aimed to compare the oncological outcomes of spinal anesthesia (SA) and general anesthesia (GA) in patients with NMIBC. METHODS: This prospective randomized controlled trial recruited 287 patients with clinical NMIBC at Seoul National University Hospital from 2018 to 2020. The patients underwent transurethral resection of the bladder tumor within 4 weeks of randomization. Intrathecal hyperbaric bupivacaine (0.5%) and a mixture of propofol (1-2 mg/kg) and fentanyl (50-100 μg/kg) were used as induction agents in the SA and GA groups, respectively, with desflurane or sevoflurane used for maintaining anesthesia. The primary and secondary outcome measures were disease recurrence and disease progression, respectively, at 2 years after resection. Cumulative incidence of outcomes was compared between the two groups using time-to-event analyses. RESULTS: 15 patients required alternative anesthesia owing to clinical needs such as SA failure or significant obturator reflex, resulting in a modified intention-to-treat (ITT) population of 272 patients. Time-to-event analysis showed a significantly lower recurrence of NMIBC in the SA group than in the GA group, in both ITT (27.4% vs 39.8%) and modified ITT populations (26.8% vs 39.6%). Disease progression occurred more frequently in the GA than in the SA group (15.2% vs 7.8%), although the difference was not statistically significant. CONCLUSIONS: A notable reduction in the 2-year recurrence rate was observed in patients who underwent SA than in those who underwent GA. Thus, SA may be considered the preferred anesthetic approach. TRIAL REGISTRATION NUMBER: NCT03597087.

References

1. 1.Han, J. H., Yuk, H. D., Jeong, S. H., Jeong, C. W., Kwak, C., Kim, J. T., & Ku, J. H. (2024). Anesthetic approaches and 2-year recurrence rates in non-muscle invasive bladder cancer: a randomized clinical trial. Regional Anesthesia and Pain Medicine. https://doi.org/10.1136/rapm-2024-105949