Results of Repeat Transurethral Resection of Bladder Tumor After Macroscopically Complete Primary Resection

Abstract

Introduction: Non-muscle invasive (NMI) bladder cancers (BC) account for 75% of BC cases, and most are initially diagnosed and treated with transurethral resection of bladder tumor (TURB). After primary TURB, a repeat resection (rTURB) should be carried out in cases of incomplete resection; however, rTURB is recommended by EAU guidelines in pT1 tumors even when the completeness of the original resection is believed by the surgeon, with reported rates of residual tumor in up to 33%-55% and upstaging in up to 25%. Since the quality of initial resection impacts in the result of a rTURB, these rates are largely dependent on the primary treatment and accurate prediction of completeness, with a probable high variability between surgeons and Centres. Our objectives to determine whether rTURB after initial perceived complete resection would frequently identify residual tumor and if this procedure would improve outcomes in NMIBC patients. Methods: Patients submitted to TURB from 2015 to 2017 were analysed, identifying which underwent rTURB after initial resection without follow-up cystoscopy in between. Primary perception of completeness, stage and grade were correlated with the eventual presence, stage and grade of residual tumor. Results: We analyzed 546 TURB procedures; of these, 275 (50.4%) were for primary bladder cancer. pT1 lesions were found in 85 (30.9%) of primary TURBs; 12 of these were selected for rTURB due to incomplete resection. Of the remaining 73 macros- copically completely resected primary pT1 tumors, 26 (30.6%) underwent elective rTURB. Repeat TURB after complete resection of primary pT1 tumors yielded residual tumor in 11.5% of patients (n= 3). All patients with residual tumor had primary pT1 high grade lesions; no upstaging or upgrading was observed. Patients had similar recurrence rates at 1-year regardless of rTURB. Discussion/Conclusion: Standard practice in primary TURB pro- cedures varies across surgeons and centers and will reflect on residual tumor rates. Indications for rTURB might not be suitable for all patients, and single Centre results should be taken in consideration when selecting patients for rTURB.