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

Summary

In a single-center RCT (n=287), spinal anesthesia significantly reduced 2-year recurrence after TURBT for NMIBC compared with general anesthesia (ITT 27.4% vs 39.8%). Disease progression trended lower with spinal anesthesia. Findings support considering spinal anesthesia as the preferred approach when feasible.

Key Findings

• Spinal anesthesia reduced 2-year recurrence compared with general anesthesia (ITT: 27.4% vs 39.8%).
• Modified ITT analysis confirmed lower recurrence with spinal anesthesia (26.8% vs 39.6%).
• Disease progression occurred less often with spinal than general anesthesia (7.8% vs 15.2%), though not statistically significant.

Clinical Implications

For TURBT in NMIBC, spinal anesthesia may be favored to reduce recurrence, balancing patient-specific contraindications and surgical needs.

Limitations

• Single-center study limits generalizability
• Blinding to anesthetic technique is inherently challenging and may introduce performance bias

Future Directions

Multicenter RCTs across diverse tumor types and mechanistic studies linking immune modulation to anesthesia technique are warranted.