Clinical rationale and safety of restaging transurethral resection in indication-stratified patients with high-risk non-muscle-invasive bladder cancer

• Published in: World journal of surgical oncology 2018-01, Vol.16 (1), p.6-6, Article 6
• Main Authors: Zapała, Piotr, Dybowski, Bartosz, Poletajew, Sławomir, Białek, Łukasz, Niewczas, Andrzej, Radziszewski, Piotr
• Format: Article
• Language: English
• Subjects: Bladder cancer; Cancer staging; Care and treatment; Diagnosis; Health aspects; Prostatectomy, Transurethral; Safety and security measures; Tumor staging; Urologic surgical procedures
• ISSN: 1477-7819; 1477-7819
• DOI: 10.1186/s12957-018-1310-0

Indications for restaging transurethral resection of the bladder tumor (reTURBT) in patients with non-muscle-invasive bladder cancer (NMIBC) remain controversial. This study was aimed at evaluation of clinical value and safety of reTURBT in different clinical indications. This is a retrospective analysis of consecutive 141 patients who underwent TURBT followed by reTURBT in years 2011-2015 in a single department. Pathological results and surgical complications were analyzed in the whole study cohort and stratified by clinical stage (Ta, T1, Tx (no muscle in the specimen)) and grade (low-grade (LG), high-grade (HG)) of bladder cancer diagnosed at primary TURBT. Full data was available for 132 patients. Residual disease was found in 53 patients (40.2%) with highest rate for Ta-HG cases (57.1%) followed by T1-HG (51.4%), Tx-HG (45.2%), T1-LG (32.1%), and Tx-LG (25.8%). In the multivariate analysis, high grade (p = 0.02) was the only independent predictor of residual disease. Upstaging to muscle-invasive bladder cancer was noticed in 9 patients (6.8%). The rate of grade ≥ 2 Clavien-Dindo complications (1.5 vs. 5.3%) did not differ significantly between TURBT and reTURBT cases. ReTURBT is a safe procedure that remains crucial for therapeutic and staging purposes in patients with T1, Tx, or high-grade bladder cancer found in the primary resection.