Selda ŞEN, Özüm TUNÇYÜREK, Ersen ERTEKİN, Mehmet DÜNDAR, İmran KURT ÖMÜRLÜ, Sinem SARI GÖKAY

The effect of spinal and general anesthesia on metastatic lymph node flow in bladder cancer surgery: A pilot study

Objectives: The sympathetic regulation of contractile function of lymphatic vessels has received much attention in terms ofmetastasis mechanism nowadays in animal studies. The aim of the study was to evaluate the effect of spinal or general anesthesiaon flow in malignant lymph nodes in patients undergoing bladder tumor surgery with Doppler ultrasound.Methods: This prospective, observational, pilot study was performed on the patients (American Society of AnesthesiologistsII and III, aged 45–85) who scheduled for elective bladder tumor surgery under spinal or general anesthesia from July 2018to August 2019. Patients were divided into two groups, spinal anesthesia and general anesthesia. Resistivity index, pulsatilityindex (PI), peak systolic velocity, and end-diastolic velocity measurements were recorded preoperatively and postoperativelyin the inguinal lymph nodes by Doppler ultrasound.Results: In the malignant lymph nodes, the PI value decreased with the spinal anesthesia (n=12) compared to the pre-operativeperiod (p=0.002) but increased in the general anesthesia group (n=11) (p=0.003). There was a significant difference in post-operativePI between the two groups (p=0.0001) (cutoff ≥5.49, sensitivity 81.82%, and specificity 91.67%). Post-operative peak systolicvelocity values were significantly higher than pre-operative values only in general anesthesia group (p=0.021).Conclusion: Lymphatic flow in metastatic lymph nodes decreased by spinal anesthesia compared to general anesthesia evaluatedusing Doppler ultrasound in our study. Although this new mechanism is new in the reduction of lymphatic metastasisduring cancer surgery, prospective randomized studies evaluating long-term recurrence and survival are warranted.

Mesane kanseri cerrahisinde spinal ve genel anestezinin metastatik lenf nodu akımı üzerine etkisi: Pilot çalışma

Amaç: Lenfatik damarların kasılma fonksiyonunun sempatik regülasyonu, günümüzde hayvan çalışmalarında metastaz mekanizması açısından çok dikkat çekmektedir. Bu çalışmanın amacı, mesane tümör cerrahisi geçiren hastalarda spinal veya genel anestezinin malign lenf nodlarındaki akım üzerine etkisini doppler ultrason ile değerlendirmektir. Gereç ve Yöntem: Bu prospektif, gözlemsel, pilot çalışma, Temmuz 2018’den Ağustos 2019’a kadar spinal veya genel anestezi altında elektif mesane tümör cerrahisi planlanan hastalarda (ASA II ve III, 45–85 yaşlarında) yapıldı. Hastalar iki gruba ayrılarak, spinal ve genel anestezi. uygulamasından önce ve sonra Doppler ultrason ile inguinal lenf nodlarında rezistivite indeksi, pulsatilite indeksi, pik sistolik hız ve end diyastolik hız ölçümleri kaydedildi. Bulgular: Malign lenf nodlarında pulsatilite indeks değeri spinal anestezi (n=12) ile ameliyat öncesi döneme (p=0.002) göre azaldı, ancak genel anestezi grubunda (n=11) arttı (p=0.003). İki grup arasında postoperatif pulsatilite indeksinde anlamlı bir fark vardı (p=0.0001) (cut off 5.49, duyarlılık %81.82, özgüllük %91.67). Postoperatif pik sistolik hız değerleri sadece genel anestezi grubunda preoperatif değerlerden anlamlı derecede yüksekti (p=0.021). Sonuç: Çalışmamızda doppler ultrasonografi ile değerlendirilen metastatik lenf nodlarındaki lenfatik akım spinal anestezi uygulamasında genel anesteziye göre azalmaktadır. Her ne kadar bu mekanizma kanser cerrahisi sırasında lenfatik metastazın azaltılmasında yeni olsa da, bu konuda uzun süreli nüks ve sağkalımı değerlendiren prospektif randomize çalışmalar gereklidir.

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