Can anesthetics affect bladder cancer recurrence? Total intravenous versus volatile anesthesia in patients undergoing robot-assisted radical cystectomy: A single institution retrospective analysis

• Published in: Urologic oncology 2021-04, Vol.39 (4), p.233.e1-233.e8
• Main Authors: Pfail, John L., Katims, Andrew B., Gul, Zeynep, Rosenzweig, Shoshana J., Razdan, Shirin, Nathaniel, Sarah, Martini, Alberto, Mehrazin, Reza, Wiklund, Peter N., Loftus, Katherine, Sim, Alan, DeMaria, Samuel, Sfakianos, John P.
• Format: Article
• Language: English
• Subjects: Cystectomy; Inhalation anesthesia; Intravenous anesthesia; Recurrence; Urinary bladder neoplasms
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2020.08.024

•Cancer recurrence is associated with many complex factors possibly including the type of anesthetic used during surgery.•Volatile inhalation anesthetics may lead to certain changes contributing to increased risk of bladder cancer recurrence.•Future studies are necessary to assess how various types of anesthetics affect bladder cancer biology. Radical cystectomy is standard of care and part of a multidisciplinary approach for long-term survival in patients with muscle-invasive bladder cancer (MIBC) or high-grade non-MIBC. Recent data have suggested that anesthetic technique can affect long-term survival and recurrence in patients undergoing cancer related surgery. The records of all patients who underwent robot-assisted radical cystectomy for high-risk non-MIBC or MIBC at a single academic institution from 2014 to 2020 were retrospectively reviewed. Patients were grouped according to whether they received total intravenous (TIVA) or volatile inhalation anesthesia (VIA). Univariable and multivariable cox proportional hazards models were used to compare hazard ratios for distant recurrence. Kaplan-Meier recurrence-free survival curves were constructed from the date of surgery to recurrence. A total of 231 patients were included, of which 126 (55%) received TIVA and 105 (45%) received VIA. Distant recurrence occurred in 8.7% and 26.7% of patients who received TIVA and VIA, respectively (P < 0.001). Kaplan-Meier analysis demonstrated significant improvement in distant recurrence-free survival with TIVA (log-rank P < 0.001). Multivariable analysis revealed a significant increase in recurrence risk with VIA (HR: 3.4, 95%CI: 1.5–7.7, P < 0.01) and increasing tumor pathological stage (pT2, pT3, pT4, all P < 0.05). The use of volatile inhalation anesthetics during robot-assisted radical cystectomy may be associated with an increased risk of distant recurrence. Further studies will be necessary to validate these findings.