Impact of Remimazolam on Prognosis After Bladder Cancer Surgery

Bladder cancer is one of the most common genitourinary cancers. Transurethral resection of bladder tumor (TURBT) is the standard therapy for nonmuscle invasive bladder cancer. However, patients after TURBT are at risk for recurrence and progression. Benzodiazepines are proved to inhibit proliferation of multiple types of cancer cells in vitro. Delirium is an acute onset and transient cerebral dysfunction and is associated with worse outcomes. Previous studies indicated that benzodiazepines increase incidence of postoperative delirium. Remimazolam is a new benzodiazepine with rapid onset and ultra-short activity. The aims of this study are to explore the impact of remimazolam for general anesthesia on emergency delirium and recurrence-free survival in patients undergoing bladder cancer surgery.

Sex

All

Minimum age

50 Years

Maximum age

90 Years

Inclusion Criteria:

1. Age ≥50 years and \<90 years;
2. Preoperative diagnosis is non-muscle-invasive bladder cancer(Ta-T1);
3. Scheduled to undergo transurethral resection of bladder tumor;
4. Agree to participate, and provide written informed consent.

Exclusion Criteria:

1. Refuse to participate;
2. Emergent surgery;
3. Combined with other malignant tumors;
4. Use of benzodiazepines for 1 week within the last month before surgery;
5. Preoperative history of schizophrenia, epilepsy, parkinsonism or myasthenia gravis;
6. Inability to communicate in the preoperative period due to coma, profound dementia, language barrier, or end-stage disease;
7. Critical illness (preoperative American Society of Anesthesiologists physical status classification ≥IV), severe hepatic dysfunction (Child-Pugh class C), or severe renal dysfunction (undergoing dialysis before surgery);
8. The purpose of surgery is to make a diagnosis or preoperative judgement is that tumor cannot be completely removed.

• BACKGROUNDChen W, Zheng R, Zhang S, Zeng H, Xia C, Zuo T, Yang Z, Zou X, He J. Cancer incidence and mortality in China, 2013. Cancer Lett. 2017 Aug 10;401:63-71. doi: 10.1016/j.canlet.2017.04.024. Epub 2017 May 3. PMID 28476483
• BACKGROUNDBabjuk M, Bohle A, Burger M, Capoun O, Cohen D, Comperat EM, Hernandez V, Kaasinen E, Palou J, Roupret M, van Rhijn BWG, Shariat SF, Soukup V, Sylvester RJ, Zigeuner R. EAU Guidelines on Non-Muscle-invasive Urothelial Carcinoma of the Bladder: Update 2016. Eur Urol. 2017 Mar;71(3):447-461. doi: 10.1016/j.eururo.2016.05.041. Epub 2016 Jun 17. PMID 27324428
• BACKGROUNDSoukup V, Capoun O, Cohen D, Hernandez V, Babjuk M, Burger M, Comperat E, Gontero P, Lam T, MacLennan S, Mostafid AH, Palou J, van Rhijn BWG, Roupret M, Shariat SF, Sylvester R, Yuan Y, Zigeuner R. Prognostic Performance and Reproducibility of the 1973 and 2004/2016 World Health Organization Grading Classification Systems in Non-muscle-invasive Bladder Cancer: A European Association of Urology Non-muscle Invasive Bladder Cancer Guidelines Panel Systematic Review. Eur Urol. 2017 Nov;72(5):801-813. doi: 10.1016/j.eururo.2017.04.015. Epub 2017 Apr 28. PMID 28457661
• BACKGROUNDAllard P, Bernard P, Fradet Y, Tetu B. The early clinical course of primary Ta and T1 bladder cancer: a proposed prognostic index. Br J Urol. 1998 May;81(5):692-8. doi: 10.1046/j.1464-410x.1998.00628.x. PMID 9634043
• BACKGROUNDHolmgren L, O'Reilly MS, Folkman J. Dormancy of micrometastases: balanced proliferation and apoptosis in the presence of angiogenesis suppression. Nat Med. 1995 Feb;1(2):149-53. doi: 10.1038/nm0295-149. PMID 7585012
• BACKGROUNDHofer SO, Molema G, Hermens RA, Wanebo HJ, Reichner JS, Hoekstra HJ. The effect of surgical wounding on tumour development. Eur J Surg Oncol. 1999 Jun;25(3):231-43. doi: 10.1053/ejso.1998.0634. PMID 10336800