Effect of regional versus general anesthesia on recurrence of non-muscle invasive bladder cancer: a systematic review and meta-analysis

Abstract Background Regional anesthesia appears to reduce cancer recurrence, but the optimal anesthesia modality for non-muscle invasive bladder cancer (NMIBC) were still under debate. Therefore, we sought to assess the effect of regional and GA only upon the recurrence and long-term prognosis of NMIBC through this meta-analysis. Methods We performed an extensive literature search of PubMed, Embase, Web of Science, the Cochrane Library and China National Knowledge Infrastructure (up to October 30, 2022) to identify eligible articles on the possible impact of different anesthetic modalities for the recurrence rate of NMIBC. Results Eight studies comprising 3764 participants, including 2117 subjects with RA and 1647 with GA, were finally enrolled. Cancer recurrence rate was significantly lower in subjects with RA than those with GA. (RR 0.84, 95%CI 0.72–0.98, P = 0.031). Significant differences were not detected between GA and RA in the time of recurrence (SMD 2.07, 95% CI -0.49-4.64, P = 0.113) and cancer progression (RR 1.14, 95%CI 0.71–1.84, P = 0.589). Results from subgroup analysis demonstrated that spinal anesthesia could significantly decrease the incidence of cancer recurrence in comparison with general anesthesia (RR 0.80, 95%CI 0.72–0.88, P < 0.001) and subjcets with high-risk NMIBC who received RA tended to have less recurrence (HR 0.55, 95%CI 0.38–0.78, P = 0.001). Conclusions RA, especially spinal anesthesia, is effective in reducing the recurrence rate after transurethral resection of NMIBC. High-risk NMIBC patients were significantly less likely to experience cancer recurrence when RA was adopted during surgery. Trial registration INPLASY registration INPLASY2022110097