{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T18:31:58Z","timestamp":1790188318939,"version":"4.1.0"},"reference-count":26,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2024,12,31]],"date-time":"2024-12-31T00:00:00Z","timestamp":1735603200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2024,12,13]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The effect of anesthesia methods on non-muscle invasive bladder cancer (NMIBC) recurrence post-resection remains uncertain. We aimed to compare the oncological outcomes of spinal anesthesia (SA) and general anesthesia (GA) in patients with NMIBC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective randomized controlled trial recruited 287 patients with clinical NMIBC at Seoul National University Hospital from 2018 to 2020. The patients underwent transurethral resection of the bladder tumor within 4\u2009weeks of randomization. Intrathecal hyperbaric bupivacaine (0.5%) and a mixture of propofol (1\u20132\u2009mg\/kg) and fentanyl (50\u2013100 \u03bcg\/kg) were used as induction agents in the SA and GA groups, respectively, with desflurane or sevoflurane used for maintaining anesthesia. The primary and secondary outcome measures were disease recurrence and disease progression, respectively, at 2 years after resection. Cumulative incidence of outcomes was compared between the two groups using time-to-event analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>15 patients required alternative anesthesia owing to clinical needs such as SA failure or significant obturator reflex, resulting in a modified intention-to-treat (ITT) population of 272 patients. Time-to-event analysis showed a significantly lower recurrence of NMIBC in the SA group than in the GA group, in both ITT (27.4% vs 39.8%) and modified ITT populations (26.8% vs 39.6%). Disease progression occurred more frequently in the GA than in the SA group (15.2% vs 7.8%), although the difference was not statistically significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A notable reduction in the 2-year recurrence rate was observed in patients who underwent SA than in those who underwent GA. Thus, SA may be considered the preferred anesthetic approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT03597087\">NCT03597087<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2024-105949","type":"journal-article","created":{"date-parts":[[2024,12,31]],"date-time":"2024-12-31T11:10:39Z","timestamp":1735643439000},"page":"379-384","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Anesthetic approaches and 2-year recurrence rates in non-muscle invasive bladder cancer: a randomized clinical trial"],"prefix":"10.1136","volume":"51","clinical-trial-number":[{"clinical-trial-number":"nct03597087","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4942-4632","authenticated-orcid":false,"given":"Jang Hee","family":"Han","sequence":"first","affiliation":[{"name":"Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyeong Dong","family":"Yuk","sequence":"additional","affiliation":[{"name":"Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung-Hwan","family":"Jeong","sequence":"additional","affiliation":[{"name":"Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang Wook","family":"Jeong","sequence":"additional","affiliation":[{"name":"Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheol","family":"Kwak","sequence":"additional","affiliation":[{"name":"Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3738-0081","authenticated-orcid":false,"given":"Jin-Tae","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0391-2342","authenticated-orcid":false,"given":"Ja Hyeon","family":"Ku","sequence":"additional","affiliation":[{"name":"Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,12,31]]},"reference":[{"key":"2026043012300838000_51.4.379.1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"key":"2026043012300838000_51.4.379.2","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2022.3050","article-title":"Management, Surveillance Patterns, and Costs Associated With Low-Grade Papillary Stage Ta Non-Muscle-Invasive Bladder Cancer Among Older Adults, 2004-2013","volume":"5","author":"Bree","year":"2022","journal-title":"JAMA Netw Open"},{"key":"2026043012300838000_51.4.379.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2023.03.029"},{"key":"2026043012300838000_51.4.379.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.201606.049"},{"key":"2026043012300838000_51.4.379.5","doi-asserted-by":"crossref","DOI":"10.1016\/j.apjon.2022.04.002","article-title":"Quality of life patterns and its association with predictors among non-muscle invasive bladder cancer survivors: A latent profile analysis","volume":"9","author":"Park","year":"2022","journal-title":"Asia Pac J Oncol Nurs"},{"key":"2026043012300838000_51.4.379.6","doi-asserted-by":"crossref","DOI":"10.1186\/s40425-018-0479-7","article-title":"High and low mutational burden tumors versus immunologically hot and cold tumors and response to immune checkpoint inhibitors","volume":"6","author":"Maleki Vareki","year":"2018","journal-title":"J Immunother Cancer"},{"key":"2026043012300838000_51.4.379.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2021.11.012"},{"key":"2026043012300838000_51.4.379.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2015.02.007"},{"key":"2026043012300838000_51.4.379.9","doi-asserted-by":"crossref","DOI":"10.1186\/s12871-016-0181-6","article-title":"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","volume":"16","author":"Jang","year":"2016","journal-title":"BMC Anesthesiol"},{"key":"2026043012300838000_51.4.379.10","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1016\/j.juro.2017.11.064","article-title":"Spinal Anesthesia is Associated with Lower Recurrence Rates after Resection of Nonmuscle Invasive Bladder Cancer","volume":"199","author":"Koumpan","year":"2018","journal-title":"J Urol"},{"key":"2026043012300838000_51.4.379.11","doi-asserted-by":"crossref","DOI":"10.3390\/jcm11041143","article-title":"A Comparison of the Anesthetic Methods for Recurrence Rates of Bladder Cancer after Transurethral Resection of Bladder Tumors Using National Health Insurance Claims Data of South Korea","volume":"11","author":"Lee","year":"2022","journal-title":"J Clin Med"},{"key":"2026043012300838000_51.4.379.12","doi-asserted-by":"crossref","DOI":"10.3389\/fonc.2023.1097637","article-title":"Association of regional anesthesia with oncological outcomes in patients receiving surgery for bladder cancer: A meta-analysis of observational studies","volume":"13","author":"Illias","year":"2023","journal-title":"Front Oncol"},{"key":"2026043012300838000_51.4.379.13","doi-asserted-by":"publisher","DOI":"10.1006\/clin.1997.4351"},{"key":"2026043012300838000_51.4.379.14","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200106000-00022"},{"key":"2026043012300838000_51.4.379.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"2026043012300838000_51.4.379.16","doi-asserted-by":"crossref","first-page":"5449","DOI":"10.2174\/1381612820666140325105723","article-title":"The effects of sevoflurane or remifentanil on the stress response to surgical stimulus","volume":"20","author":"Alsina","year":"2014","journal-title":"Curr Pharm Des"},{"key":"2026043012300838000_51.4.379.17","first-page":"336","article-title":"The perioperative immune response","volume":"21","author":"O\u2019Dwyer","year":"2015","journal-title":"Curr Opin Crit Care"},{"key":"2026043012300838000_51.4.379.18","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2018-000001"},{"key":"2026043012300838000_51.4.379.19","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1007\/s00345-018-2375-7","article-title":"Intravesical BCG treatment causes a long-lasting reduction of recurrence and progression in patients with high-risk non-muscle-invasive bladder cancer","volume":"37","author":"Thiel","year":"2019","journal-title":"World J Urol"},{"key":"2026043012300838000_51.4.379.20","doi-asserted-by":"crossref","DOI":"10.1186\/s12957-023-02957-3","article-title":"Regional anesthesia did not improve postoperative long-term survival of tumor patients: a systematic review and meta-analysis of randomized controlled trials","volume":"21","author":"Li","year":"2023","journal-title":"World J Surg Oncol"},{"key":"2026043012300838000_51.4.379.21","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1097\/ALN.0000000000003835","article-title":"Long-term Survival after Combined Epidural-General Anesthesia or General Anesthesia Alone: Follow-up of a Randomized Trial","volume":"135","author":"Du","year":"2021","journal-title":"Anesthesiology"},{"key":"2026043012300838000_51.4.379.22","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1097\/ALN.0000000000003873","article-title":"Epidural Anesthesia-Analgesia and Recurrence-free Survival after Lung Cancer Surgery: A Randomized Trial","volume":"135","author":"Xu","year":"2021","journal-title":"Anesthesiology"},{"key":"2026043012300838000_51.4.379.23","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)32313-X"},{"key":"2026043012300838000_51.4.379.24","doi-asserted-by":"crossref","first-page":"837959","DOI":"10.3389\/fonc.2022.837959","article-title":"Potential Influence of Anesthetic Interventions on Breast Cancer Early Recurrence According to Estrogen Receptor Expression: A Sub-Study of a Randomized Trial","volume":"12","author":"Li","year":"2022","journal-title":"Front Oncol"},{"key":"2026043012300838000_51.4.379.25","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.eururo.2017.06.038","article-title":"Value of an Immediate Intravesical Instillation of Mitomycin C in Patients with Non-muscle-invasive Bladder Cancer: A Prospective Multicentre Randomised Study in 2243 patients","volume":"73","author":"Bosschieter","year":"2018","journal-title":"Eur Urol"},{"key":"2026043012300838000_51.4.379.26","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1097\/ALN.0000000000002506","article-title":"Anesthesia and Cancer Recurrence: Context for Divergent Study Outcomes","volume":"130","author":"Sessler","year":"2019","journal-title":"Anesthesiology"}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2024-105949","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T19:30:34Z","timestamp":1777577434000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2024-105949"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,31]]},"references-count":26,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,2]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/rapm-2024-105949"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2024-105949","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"value":"1098-7339","type":"print"},{"value":"1532-8651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,31]]}}}