Association of regional anesthesia with oncological outcomes in patients receiving surgery for bladder cancer: A meta-analysis of observational studies

Amina M Illias; Kai-Jie Yu; Shao-Chun Wu; Juan P Cata; Yung-Fong Tsai; Kuo-Chuan Hung

doi:10.3389/fonc.2023.1097637

Association of regional anesthesia with oncological outcomes in patients receiving surgery for bladder cancer: A meta-analysis of observational studies

Front Oncol. 2023 Feb 22:13:1097637. doi: 10.3389/fonc.2023.1097637. eCollection 2023.

Authors

Amina M Illias^{1

2}, Kai-Jie Yu³, Shao-Chun Wu⁴, Juan P Cata⁵, Yung-Fong Tsai¹, Kuo-Chuan Hung^{6

7}

Affiliations

¹ Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
² Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
³ Department of Urology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
⁴ Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
⁵ Department of Anesthesiology and Perioperative Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States.
⁶ Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.
⁷ School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan.

Abstract

Background: This meta-analysis was conducted to compare cancer recurrence and survival rates in patients with bladder cancer receiving surgery under general anesthesia alone (i.e., GA group) or regional anesthesia (RA) with or without GA (i.e., RA ± GA group).

Methods: Literature search on Cochrane library, EMBASE, Google scholar, and Medline databases was performed to identify all relevant studies from inception to April 30, 2022. The primary outcome was cancer recurrence rate, while the secondary outcomes included overall survival rate and cancer-specific survival rate. Subgroup analyses were performed based on study design [(Propensity-score matching (PSM) vs. no-PSM)] and type of surgery [transurethral resection of bladder tumor (TURBT) vs. radical cystectomy].

Results: Ten retrospective studies with a total of 13,218 patients (RA ± GA group n=4,884, GA group n=8,334) were included. There was no difference between RA ± GA group and GA group in age, the proportion of males, severe comorbidities, the proportion of patients receiving chemotherapy, and the pathological findings (all p >0.05). Patients in the RA ± GA group had significantly lower rate of bladder cancer recurrence [odds ratio (OR): 0.74, 95%CI: 0.61 to 0.9, p=0.003, I^{2 =} 24%, six studies] compared to those in the GA group. Subgroup analyses based on study design revealed a consistent finding, while the beneficial effect of RA ± GA on reducing cancer recurrence was only significant in patients receiving TURBT (p=0.02), but not in those undergoing radical cystectomy (p=0.16). There were no significant differences in overall survival rate and cancer-specific survival rate between RA ± GA and GA groups.

Conclusions: For patients receiving surgery for bladder cancer, the application of regional anesthesia with or without general anesthesia is associated with significant decrease in cancer recurrence, especially in patients undergoing TURBT for non-muscle invasive bladder cancer. Because of the limited number of studies included and potential confounding factors, our results should be interpreted carefully.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022328134.

Keywords: bladder cancer; cancer recurrence; general anesthesia; meta-analysis; regional anesthesia; survival rate.

Publication types

Systematic Review

Grants and funding

This research was funded by Chi Mei Medical Center, Tainan, Taiwan, grant number CMOR11203.