Risk Gruplarına Göre Non-Muscle İnvaziv Mesane Tümörünün Nüksüne Anestezi Türünün Etkisi: 3 Yıllık Takip

Year 2025, Volume: 18 Issue: 1, 5 - 5

Sinan Çelen , Aslı Mete , Yusuf Özlülerden , Mesut Berkan Duran , Kürşat Küçüker , Alper Şimşek , Aykut Başer , Yunus Yaz , Kadir Ömür Günseven

https://doi.org/10.31362/patd.1443444

Abstract

Amaç: Mesane kanseri nüksünü etkileyen genetik ve çevresel faktörler gibi birçok risk faktörü önceden belirlenmiştir. İmmünsüpresyon yaratan risk faktörlerinin, kanser hücrelerinin yayılmasında rol oynadığı belirtilmiştir. Perioperatif bir faktör olan anestezik ajan, bağışıklık sistemini bozarak kanser nüksü riskini etkileyebilir. Bu çalışmanın amacı, bölgesel anestezi (BA) ve genel anestezi (GA) etkilerini özellikle kas invaziv olmayan mesane kanseri (KİOMK) nüksü üzerinde karşılaştırmaktır.
Materyal ve Metod: Pamukkale Üniversitesi ve Uludağ Üniversitesi üroloji bölümlerinde 2011-2016 yılları arasında KİOMK için transüretral mesane tümör rezeksiyonu (TURM) geçiren toplamda 178 hasta çalışmaya dahil edildi. Birinci grupta 80 hasta BA aldı. İkinci grupta ise 98 hasta KİOMK için TURM sırasında GA aldı.
Bulgular: Nüks süresi GA grubunda (5.5 ay) BA grubundan (11 ay) daha kısa idi (p=0.015). İlk yıl nüks, GA grubunda BA grubuna göre daha yüksekti (p=0.048), ancak gruplar arasında üçüncü yıl nüksünde farklılık yoktu (p=0.810). Ortalama nüks süresi BA grubunda 11 ay (95% CI; 9.058-12.942) ve GA grubunda 5 ay (95% CI; 2.090-7.910) idi (p=0.031).
Sonuç: Mesane tümörünün transüretral rezeksiyonu sırasında BA alan orta riskli KİOMK hastalarında GA alan hastalara göre nüks süresinde artış gözlendi. BA, nüks gecikmesinde 7 aylık bir fayda sağladı.

Keywords

Mesane kanseri, mesane tümörü, bölgesel anestezi, genel anestezi.

The influence of anesthesia type on recurrence of the non-muscle invasive bladder tumor according to risk groups: 3 year follow up

Abstract

Purpose: Many risk factors affecting bladder cancer recurrence, such as genetic and environmental factors, have been previously identified. It has been stated that risk factors that cause immunosuppression play a role in the spread of cancer cells. Anesthetic agent, which is a perioperative factor, may affect the risk of cancer recurrence by disrupting the immune system. The aim of this study was to compare the effect of regional anesthesia (RA) and general anesthesia (GA) on non-muscle invasive bladder cancers (NMIBC) recurrence.
Materials and methods: A total of one hundred seventy-eight patients who underwent transurethral bladder tumor resection (TURBT) for NMIBC and underwent surgery under GA or RA between 2011 and 2016 in the urology departments of Pamukkale University and Uludağ University were included in the study. In the first group, 80 patients had RA. In the second group, 98 patients underwent GA during TURBT for NMIBC.
Results: The recurrence time was shorter in the GA group (5.5 months) than in the RA group (11 months) (p=0.015). First-year relapse was higher in the GA group than in the RA group (p=0.048), but there was no difference in third-year relapse between groups (p=0.810). The mean recurrence time was 11 months (95% CI; 9.058 - 12.942) in the RA group and 5 months (95% CI; 2.090 - 7.910) in the GA group (p=0.031).
Conclusion: During transurethral resection of the bladder tumor, an increase in the recurrence time was observed in patients with intermediate-risk NMIBC who received RA compared to patients who received GA. RA provided a 7-month benefit in relapse delay.

Keywords

Bladder cancer, bladder tumor, regional anesthesia, general anesthesia

References

• Cata JP, Hernandez M, Lewis VO, Kurz A. Can regional anesthesia and analgesia prolong cancer survival after orthopaedic oncologic surgery?. Clin Orthop Relat Res. 2014;472(5):1434-1441. doi:10.1007/s11999-013-3306-y
• Faba OR, Palou J, Breda A, Villavicencio H. High-risk non-muscle-invasive bladder cancer: update for a better identification and treatment. World J Urol. 2012;30:833-840. doi:10.1007/s00345-012-0967-1
• Cassinello F, Prieto I, del Olmo M, Rivas S, Strichartz GR. Cancer surgery: how may anesthesia influence outcome?. J Clin Anesth. 2015;27(3):262-272. doi:10.1016/j.jclinane.2015.02.007
• Lusty AJ, Hosier GW, Koti M, et al. Anesthetic technique and oncological outcomes in urology: A clinical practice review. Urol Oncol. 2019;37(12):845-852. doi:10.1016/j.urolonc.2019.08.004
• Kim R. Anesthetic technique and cancer recurrence in oncologic surgery: unraveling the puzzle. Cancer Metastasis Rev. 2017;36(1):159-177. doi:10.1007/s10555-016-9647-8
• Sun Y, Li T, Gan TJ. The Effects of Perioperative Regional Anesthesia and Analgesia on Cancer Recurrence and Survival After Oncology Surgery: A Systematic Review and Meta-Analysis. Reg Anesth Pain Med. 2015;40(5):589-598. doi:10.1097/AAP.0000000000000273
• Sylvester RJ, van der Meijden AP, Oosterlinck W, et al. Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol. 2006;49(3):466-477. doi:10.1016/j.eururo.2005.12.031
• Koumpan Y, Jaeger M, Mizubuti GB, et al. Spinal Anesthesia is Associated with Lower Recurrence Rates after Resection of Nonmuscle Invasive Bladder Cancer. J Urol. 2018;199(4):940-946. doi:10.1016/j.juro.2017.11.064
• Deegan CA, Murray D, Doran P, Ecimovic P, Moriarty DC, Buggy DJ. Effect of anaesthetic technique on oestrogen receptor-negative breast cancer cell function in vitro [published correction appears in Br J Anaesth. 2010 Apr;104(4):516]. Br J Anaesth. 2009;103(5):685-690. doi:10.1093/bja/aep261
• Wada H, Seki S, Takahashi T, et al. Combined spinal and general anesthesia attenuates liver metastasis by preserving TH1/TH2 cytokine balance. Anesthesiology. 2007;106(3):499-506. doi:10.1097/00000542-200703000-00014
• Ahlers O, Nachtigall I, Lenze J, et al. Intraoperative thoracic epidural anaesthesia attenuates stress-induced immunosuppression in patients undergoing major abdominal surgery. Br J Anaesth. 2008;101(6):781-787. doi:10.1093/bja/aen287
• Yang W, Cai J, Zhang H, Wang G, Jiang W. Effects of Lidocaine and Ropivacaine on Gastric Cancer Cells Through Down-regulation of ERK1/2 Phosphorylation In Vitro. Anticancer Res. 2018;38(12):6729-6735. doi:10.21873/anticanres.13042
• Folkman J. Role of angiogenesis in tumor growth and metastasis. Semin Oncol. 2002;29(6 Suppl 16):15-18. doi:10.1053/sonc.2002.37263
• Temeltaş G, Kosova F, Ucer O, Muezzinoglu T, Arı Z. Effects of treatment on angiogenic (Vascular Endothelial Growth Factor-2 and Matrix Metalloproteinase-2) and antiangiogenic (Endostatin and Thrombospondin-1) factors in non-muscle invasive bladder carcinoma. J Urol Surg. 2017;4(2):71-75. doi:10.4274/jus.1306
• Byrne K, Levins KJ, Buggy DJ. Can anesthetic-analgesic technique during primary cancer surgery affect recurrence or metastasis? Can J Anaesth. 2016;63:184-192. doi:10.1007/s12630-015-0523-8
• Martin Kleiner I, Balog T, Gabrilovac J. Signal transduction induced by opioids in immune cells: a review. Neuroimmunomodulation. 2006;13(1):1-7. doi:10.1159/000092107
• Gupta K, Kshirsagar S, Chang L, et al. Morphine stimulates angiogenesis by activating proangiogenic and survival-promoting signaling and promotes breast tumor growth. Cancer Res. 2002;62(15):4491-4498.
• Lee BM, Singh Ghotra V, Karam JA, Hernandez M, Pratt G, Cata JP. Regional anesthesia/analgesia and the risk of cancer recurrence and mortality after prostatectomy: a meta-analysis. Pain Manag. 2015;5(5):387-395. doi:10.2217/pmt.15.30
• Christopher Doiron R, Jaeger M, Booth CM, Wei X, Robert Siemens D. Is there a measurable association of epidural use at cystectomy and postoperative outcomes? A population-based study. Can Urol Assoc J. 2016;10(9-10):321-327. doi:10.5489/cuaj.3856
• Jang D, Lim CS, Shin YS, et al. A comparison of regional and general anesthesia effects on 5 year survival and cancer recurrence after transurethral resection of the bladder tumor: a retrospective analysis. BMC Anesthesiol. 2016;16:16. Published 2016 Mar 12. doi:10.1186/s12871-016-0181-6
• Choi WJ, Baek S, Joo EY, et al. Comparison of the effect of spinal anesthesia and general anesthesia on 5-year tumor recurrence rates after transurethral resection of bladder tumors. Oncotarget. 2017;8(50):87667-87674. Published 2017 Sep 16. doi:10.18632/oncotarget.21034
• Woldu SL, Bagrodia A, Lotan Y. Guideline of guidelines: non-muscle-invasive bladder cancer. BJU Int. 2017;119(3):371-380. doi:10.1111/bju.13760
• Nicolazzo C, Busetto GM, Gradilone A, et al. Circulating Tumor Cells Identify Patients with Super-High-Risk Non-Muscle-Invasive Bladder Cancer: Updated Outcome Analysis of a Prospective Single-Center Trial. Oncologist. 2019;24(5):612-616. doi:10.1634/theoncologist.2018-0784
• Soria F, Krabbe LM, Todenhöfer T, et al. Molecular markers in bladder cancer. World J Urol. 2019;37(1):31-40. doi:10.1007/s00345-018-2503-4