Minimally Invasive Colorectal Surgery Under General Versus Neuraxial Anesthesia: A Retrospective Propensity-Score-Matched Analysis

<b>Background</b>: Neuraxial anesthesia, delivered as a combined spinal-epidural without intubation or neuromuscular blockade, is a promising alternative for patients undergoing minimally invasive colorectal surgery. Evidence is limited to case series, with no cohort studies available. <b>Methods</b>: This is a retrospective analysis of consecutive patients undergoing minimally invasive colorectal surgery for both benign and malignant disease at a single institution, between October 2022 and October 2024. Patients were divided by the type of anesthesia. Propensity score matching was performed to reduce confounding bias. Outcomes assessed included anesthesiologic preparation time, duration of surgery, intraoperative features, intensive care unit admission, length of hospital stay, and 90-day postoperative complications, including anastomotic leak and readmission rates. <b>Results</b>: Thirty-two patients (40.5%) received neuraxial anesthesia and forty-seven (59.5%) received general anesthesia. No conversions from neuraxial to general anesthesia occurred. After matching, anesthesia preparation time was longer in the neuraxial group (42.5 vs. 30 min, <i>p</i> = 0.011), while operative time was significantly shorter (181 vs. 231 min, <i>p</i> = 0.002). Length of stay, postoperative complications, including leak, and readmission rates were comparable between groups. <b>Conclusions</b>: Neuraxial anesthesia may be a valid alternative to general anesthesia for minimally invasive colorectal surgery. In this single-center experience, it required longer anesthetic preparation but was associated with shorter operative times, without affecting surgical outcomes or increasing complication rates. These results support further investigation into its application in colorectal procedures.