Mp22-15 the Use of Perioperative Opioids Is Oncologically Safe in Patients Undergoing Radical Cystectomy for Urothelial Carcinoma of the Bladder

You have accessJournal of UrologyBladder Cancer: Invasive II (MP22)1 May 2024MP22-15 THE USE OF PERIOPERATIVE OPIOIDS IS ONCOLOGICALLY SAFE IN PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR UROTHELIAL CARCINOMA OF THE BLADDER Julian Marcon, Fatima Yefsah, Gerald B. Schulz, Philipp Weinhold, Lennert Eismann, Yannic Volz, Paulo L. Pfitzinger, Christian G. Stief, Daniel Siegl, Alexander Buchner, and Jan-Friedrich Jokisch Julian MarconJulian Marcon , Fatima YefsahFatima Yefsah , Gerald B. SchulzGerald B. Schulz , Philipp WeinholdPhilipp Weinhold , Lennert EismannLennert Eismann , Yannic VolzYannic Volz , Paulo L. PfitzingerPaulo L. Pfitzinger , Christian G. StiefChristian G. Stief , Daniel SieglDaniel Siegl , Alexander BuchnerAlexander Buchner , and Jan-Friedrich JokischJan-Friedrich Jokisch View All Author Informationhttps://doi.org/10.1097/01.JU.0001008608.50694.4b.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical cystectomy (RC) is the surgical gold standard for muscle-invasive bladder cancer (MIBC) and high-risk non-muscle invasive bladder cancer (NMBIC). However, up to 40% of patients eventually present with tumor recurrence and progress. Intraoperative opioid dose has been shown to be associated with worse prognosis in several cancers. We aimed to investigate the effect of intraoperatively administered opioids on survival in patients who underwent RC for urothelial carcinoma of the bladder. METHODS: After IRB approval, we queried our internal database for patients who underwent open radical cystectomy at our center between 2015 and 2022. Only patients with complete demographic data, full documentation of perioperatively applied opioids and comprehensive follow-up information were included. Remifentanil (RFT) and sufentanil (SFT) were used as intravenous opioids in all cases. Cancer-specific survival (CSS), overall survival (OS) and recurrence-free survival (RFS) were calculated from the time of RC to the time of death, recurrence, or last follow-up. Survival estimates were computed using Cox regression analysis. A p-value of ≤0.05 was considered statistically significant. RESULTS: A total of 517 patients, who had undergone RC for urothelial carcinoma of the bladder, were identified. The study cohort included a total of 390 men (75.4%) and 127 women (24.6%), the median age at the time of diagnosis was 73.1 years (IQR: 64.2-78.5). Final histology showed localized disease (Cis/T1/T2) in 258 cases and locally advanced disease (T3/T4) in 259 patients. The median follow-up time was 8.9 months (IQR: 3.1-26.9). A total of 94 patients (18.2%) underwent intravenous anesthesia only, while 423 (81.8%) received additional epidural anesthesia. The median intraoperative RFT dose was 4667 µg (IQR: 2828-7187), the median intraoperative SFT dose was 100 µg (IQR:100-300). The dose of RFT or SFT was not significantly associated with CSS (both HR: 1.0; p=0.27 and p=0.14, respectively), OS (HR: 0.99/p=0.65 and HR: 1.0/p=0.32, respectively) or RFS (both HR: 1.0; p=0.17 and p=0.49, respectively) upon Cox analysis. Interestingly, a significant difference in OS between patients undergoing intravenous opioids only and those receiving additional epidural anesthesia was observed in our cohort (HR: 0.62, p=0.035), with no significant difference in opioid doses between groups. CONCLUSIONS: The use of intraoperative opioids was not associated with adverse prognosis in our cohort, while the use of additional epidural anesthesia was observed to be beneficial. Further research in the form of multicenter studies could validate the safety of opioids in patients undergoing RC. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e348 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Julian Marcon More articles by this author Fatima Yefsah More articles by this author Gerald B. Schulz More articles by this author Philipp Weinhold More articles by this author Lennert Eismann More articles by this author Yannic Volz More articles by this author Paulo L. Pfitzinger More articles by this author Christian G. Stief More articles by this author Daniel Siegl More articles by this author Alexander Buchner More articles by this author Jan-Friedrich Jokisch More articles by this author Expand All Advertisement PDF downloadLoading ...