The Effect of Spinal and General Anesthesia on Metastatic Lymph Node Flow in Bladder Cancer Surgery: A Pilot Study

The sympathetic regulation of contractile function of lymphatic vessels has received much attention in terms of metastasis mechanism nowadays in animal studies. The aim of the study to evaluate the effect of spinal or general anesthesia on flow in malignant lymph nodes in patients undergoing bladder tumor surgery with doppler ultrasound.

This prospective, observational, pilot study was performed on the patients (ASA II and III, aged 45-85) who scheduled for elective bladder tumor surgery under spinal or general anesthesia from July 2018 to August 2019. Patients were divided into two groups, spinal anesthesia and general anesthesia. Resistivity index, pulsatility index, peak systolic velocity and end diastolic velocity measurements were recorded preoperatively and postoperatively n the inguinal lymph nodes by doppler ultrasound.

In the malignant lymph nodes, the pulsatility index value decreased with the spinal anesthesia (n=12) compared to the preoperative period (p = 0.002) but increased in the general anesthesia group (n=11) (p = 0.003). There was a significant difference in postoperative pulsatility index between the two groups (p = 0.0001) (cut off => 5.49, sensitivity 81.82%, specificity 91.67%). Postoperative peak systolic velocity values were significantly higher than preoperative values only in general anesthesia group (p = 0.021).

Lymphatic flow in metastatic lymph nodes decreased by spinal anesthesia compared to general anesthesia evaluated by using doppler ultrasound in our study. Although this new mechanism is new in the reduction of lymphatic metastasis during cancer surgery, prospective randomized studies evaluating long-term recurrence and survival are warranted.