What ' s known on the subject? and What does the study add? Apart from bladder tumour multiplicity, size, stage, grade and presence of cis, early recurrence following white light TURBT for new bladder tumours is also determined by surgeon experience, completeness of resection and presence or absence of detrusor muscle in the specimen.This study aims to validate surgeon experience and detrusor muscle as independent predictors of early recurrence following apparently complete white light TURBT in new bladder tumours.
OBJECTIVE• To validate in patients undergoing fi rst transurethral resection of bladder tumour (TURBT) for non-muscle-invasive bladder cancer (NMIBC), the presence/absence of detrusor muscle (DM) in the specimen and surgeon experience as independent predictors of the quality of TURBT.
PATIENTS AND METHODS• Patients with new NMIBC, who had undergone complete fi rst resections were recruited from a prospectively maintained cohort from the 1980s at the Western General Hospital, Edinburgh, UK and a contemporary cohort from the Aberdeen Royal Infi rmary, UK.• Tumour size, multiplicity, surgeon category, presence or absence of DM in the specimen, grade, stage, fi ndings at fi rst check cystoscopy and early re-TURBT were evaluated.• Surgeons were stratifi ed into a senior group (consultant and trainees in year fi ve or six) and a junior group (trainees below year fi ve).• Early recurrence, or recurrence rate at the fi rst follow up cystoscopy (RRFFC), was used to measure quality and was defi ned as fi nding pathologically confi rmed tumour at early re-TURBT or the fi rst check cystoscopy.
RESULTS• From a total of 566 patients evaluated from both cohorts, 473 NMIBC specimens were suitable for analysis.• Logistic regression multivariate analysis revealed that the absence of DM was associated with a higher RRFFC (odds ratio [ OR ] = 3.6, 95% CI = 1.7 -7.5, P < 0.001).• Senior surgeons were more likely to resect DM (OR = 4.9, 95% CI = 2.3 -10.7, P < 0.001)• Senior surgeons were independently associated with a lower RRFFC (OR = 5.3, 95% CI = 2.1 -12.9, P < 0.001).
CONCLUSIONS• Detrusor muscle status at the fi rst, apparently complete, TURBT and surgeon ' s experience independently predict the quality of TURBT.• Documented complete resection by experienced surgeons with DM presence (good quality white-light TURBT) should be considered a benchmark for white-light TURBT in NMIBC.
KEYWORDSbladder cancer , transurethral resection of bladder tumour , quality control , recurrence , detrusor muscle Study Type -Therapy (cohort) Level of Evidence 2b
