The impact of regional anesthesia on bladder cancer outcomes.

Abstract

e15021 Background: Studies in breast and prostate surgery show reduced cancer recurrence after regional (RA) versus general anesthesia (GA). Mechanisms include RAÕs reduced post-operative opioid use and cortisol-mediated immunosuppression. RA may be used alone during transurethral resection of bladder tumors (TURBT) and in combination with GA during radical cystectomy (RC). We assess the impact of RA on short-term bladder urothelial cell carcinoma (UCC) recurrence after TURBT or RC. Methods: From 8/2001 and 6/2006 to 6/2011, 151 patients underwent RC and 488 patients underwent TURBT for bladder UCC, respectively. Those with incomplete resection on TURBT were excluded. Anesthesia included RA or GA for TURBT, and GA alone or GA + RA for RC. Multivariate logistic regression was performed to identify significant predictors of biopsy- or radiography-confirmed UCC recurrence. Results: TURBT. Of 252 patients, 211 received GA and 41 received RA during TURBT. Patient and operative characteristics were similar between groups. Recurrence was 56% at 12 months for GA and RA. Multivariate analysis revealed clinical stage to be the only predictor of UCC recurrence (HR=1.8, p<0.0001). Anesthesia had no affect on 6 or 12 month RFS, DSS or OS (see table). RC. GA was used in 114 patients and 37 patients had GA + RA at RC. There were no between group differences in patient or tumor characteristics. After follow-up of 18 months, 25.9% and 21.6% recurred in GA and GA+RA groups, respectively (p>0.05). There were no differences in RFS, DSS, or OS (see Table). Conclusions: Contrary to other malignancies, our data suggest anesthesia type at TURBT or RC does not affect bladder cancer outcomes. Anesthesia modality should be based on patient comorbidities and procedure type. [Table: see text]