Is Repeat Transurethral Resection Always Needed in High-Grade T1 Bladder Cancer?

Abstract

Re-staging transurethral resection, the so-called repeat TUR (Re-TUR), is mandatory in case of incomplete first transurethral resection of bladder tumor (TURBT). In completely resected high grade T1 tumors, Re-TUR is recommended but question remains whether it provides advantages in terms of recurrence-free survival (RFS), progression-free survival (PFS), and cancer specific survival (CSS). The present study aimed to determine whether Re-TUR improves such outcomes in patients with completely resected high-grade T1 bladder cancer (BC). We queried our prospectively maintained database to identify patients with completely resected high-grade T1 BC who underwent (Group A) or not (Group B) Re-TUR before starting intravesical instillations of Bacillus Calmette-Guerin (BCG). The impact of Re-TUR as well as of other tested variables on RFS, PFS, and CSS was tested by Kaplan-Meier method and Log-rank testing. A total of 118 patients underwent Re-TUR, which pointed out no BC in 61 (51.7%), NMIBC in 54 (45.8%) and pT2 disease in 3 (2.5%). The 3 patients with pT2 disease underwent cystectomy, whereas all others were offered BCG treatment. Forty-two patients refused BCG treatment while 2 did not complete it; therefore, Group A (Re-TUR before BCG treatment) consisted of 71 patients whereas Group B consisted of 40 patients who refused Re-TUR but completed BCG treatment. Mean follow-up was 60 months (range 12-142). Kaplan-Meier curves and Log-rank testing showed no difference in RFS, PFS and CSS between patients who had (Group A) or had not (Group B) Re-TUR before starting BCG treatment. Our findings suggest that a Re-TUR in patients with a completely resected high-grade T1 BC does not translate into a better oncological outcome. Given its impact on both patients and healthcare system, the need for Re-TUR in completely resected high grade T1 BC should be further investigated into the framework of a randomized study.

Impact of time to second transurethral resection on oncological outcomes of patients with high-grade T1 bladder cancer treated with intravesical Bacillus Calmette–Guerin

“…presence of healthy detrusor muscle in the first TURBT specimen) high-grade (HG) T1 BC treated with intravesical BCG, Re-TUR did not improve RFS, PFS, and CSS [3]. Similar findings were obtained in a recent study addressing this issue in a homogeneous population of patients with completely resected HG T1 BC treated with intravesical BCG [4], thus questioning the dogmatic need for such additional surgical procedure, given its patients and healthcare burdens.…”

Which Non-Muscle Invasive Bladder Cancer Is More Valuable For Re-transurethral resection?

“…They reported that the oncological results and the rate of recurrence / progression will not be affected after re-TUR for T1_high-grade. Moreover, re-TUR can cause patient distress and higher re-operation related healthcare costs 21 . In our study, we could not find any statically significant relation between re-TUR and recurrence/progression.…”

Slingshot homolog-1 expression is a poor prognostic factor of pT1 bladder urothelial carcinoma after transurethral resection

“…Although second-look TUR-BT has been recommended for patients with stage pT1 BT after initial operation for re-staging and deciding the subsequent therapy. Some scholars queried the need for such additional surgical intervention, considering the patients and healthcare burdens, and the survival benefits of second-look TUR-BT is still controversial at present [ 12 , 16 ]. Hence, the majority of patients with stage pT1 bladder UC were not performed re-TUR-BT in our institution.…”