Association of regional anesthesia with oncological outcomes in patients receiving surgery for bladder cancer: A meta-analysis of observational studies
BackgroundThis 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).MethodsLiterature search on Cochrane libra...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-02-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2023.1097637/full |
| _version_ | 1797900666089242624 |
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| author | Amina M. Illias Amina M. Illias Kai-Jie Yu Shao-Chun Wu Juan P. Cata Yung-fong Tsai Kuo-Chuan Hung Kuo-Chuan Hung |
| author_facet | Amina M. Illias Amina M. Illias Kai-Jie Yu Shao-Chun Wu Juan P. Cata Yung-fong Tsai Kuo-Chuan Hung Kuo-Chuan Hung |
| author_sort | Amina M. Illias |
| collection | DOAJ |
| description | BackgroundThis 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).MethodsLiterature 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].ResultsTen 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, I2 = 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.ConclusionsFor 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 registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42022328134. |
| first_indexed | 2024-04-10T08:48:31Z |
| format | Article |
| id | doaj.art-e85f70acee084c0a9f7e5620e1d94915 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-04-10T08:48:31Z |
| publishDate | 2023-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-e85f70acee084c0a9f7e5620e1d949152023-02-22T05:08:10ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2023-02-011310.3389/fonc.2023.10976371097637Association of regional anesthesia with oncological outcomes in patients receiving surgery for bladder cancer: A meta-analysis of observational studiesAmina M. Illias0Amina M. Illias1Kai-Jie Yu2Shao-Chun Wu3Juan P. Cata4Yung-fong Tsai5Kuo-Chuan Hung6Kuo-Chuan Hung7Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, TaiwanGraduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, TaiwanDepartment of Urology, Chang Gung Memorial Hospital, Taoyuan, TaiwanDepartment of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, TaiwanDepartment of Anesthesiology and Perioperative Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United StatesDepartment of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, TaiwanDepartment of Anesthesiology, Chi Mei Medical Center, Tainan, TaiwanSchool of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, TaiwanBackgroundThis 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).MethodsLiterature 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].ResultsTen 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, I2 = 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.ConclusionsFor 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 registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42022328134.https://www.frontiersin.org/articles/10.3389/fonc.2023.1097637/fullregional anesthesiageneral anesthesiabladder cancermeta-analysiscancer recurrencesurvival rate |
| spellingShingle | Amina M. Illias Amina M. Illias Kai-Jie Yu Shao-Chun Wu Juan P. Cata Yung-fong Tsai Kuo-Chuan Hung Kuo-Chuan Hung Association of regional anesthesia with oncological outcomes in patients receiving surgery for bladder cancer: A meta-analysis of observational studies Frontiers in Oncology regional anesthesia general anesthesia bladder cancer meta-analysis cancer recurrence survival rate |
| title | Association of regional anesthesia with oncological outcomes in patients receiving surgery for bladder cancer: A meta-analysis of observational studies |
| title_full | Association of regional anesthesia with oncological outcomes in patients receiving surgery for bladder cancer: A meta-analysis of observational studies |
| title_fullStr | Association of regional anesthesia with oncological outcomes in patients receiving surgery for bladder cancer: A meta-analysis of observational studies |
| title_full_unstemmed | Association of regional anesthesia with oncological outcomes in patients receiving surgery for bladder cancer: A meta-analysis of observational studies |
| title_short | Association of regional anesthesia with oncological outcomes in patients receiving surgery for bladder cancer: A meta-analysis of observational studies |
| title_sort | association of regional anesthesia with oncological outcomes in patients receiving surgery for bladder cancer a meta analysis of observational studies |
| topic | regional anesthesia general anesthesia bladder cancer meta-analysis cancer recurrence survival rate |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2023.1097637/full |
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