AUA 2018: Correlation between Surgeon’s Experience and Pathological and Oncological Outcomes after Transurethral Resection of the Bladder

San Francisco, CA ( Oncological outcomes for patients with non-muscle invasive bladder cancer (NIMBC) have been significantly correlated with the quality of the transurethral resection of the bladder tumor (TURBT). A quality TURBT is defined as one that removes all visible lesions, with the presence of adequate detrusor muscle for accurate staging. Several reports have shown that surgeon experience as the most important factor associated with pathological quality assessment and superior clinical outcomes (recurrence and progression rates). Dr. Naspro, from Bergamo Italy, presents a multi-institutional retrospective review aimed to assess the correlation between the surgeon's experience and the pathological and oncological outcomes of NIMBC undergoing a TURBT at 4 high volume centers. 

The study included 410 patients who underwent a TURBT for NMIBC at 4 northern Italian treating institutions. Surgeon experience was classified as a junior (JS) (<100 TURBTs), intermediate (IS) (100<TURBTs<250) and expert (ES)(>250 TURBTs). For each procedure we reported the presence of detrusor muscle (SM) in bladder specimen, any complication using the Clavien-Dindo classification, need for a repeat TURBT (except those with the high-grade disease) and recurrence at three months. 

The procedures were performed by JS (64/410 (15.6%)), IS (108/410 (26.6%)), and ES (238/410 (58%)), respectively. Complications were recorded in 6/64 (9.3%), 3/108 (2,7%) and 28/238 (11,7%) patients in the JS, IS and ES groups. 3-month recurrence was found in 9/48 (18,75%), 10/70 (14,28%), 34/161 (21,1%) of the JS, IS and ES groups, respectively. Overall, 80/410 (19.5%) patients underwent re-TURBT, of which the first TUR was performed by JS, IS or ES in 13/80 (16.25%), 24/80(30%), 43/80(53.7%) patients, respectively. Status of DM was reported in 59/64 (92,1%), 102/108 (94,4%), 173/238 (72,6%) in the JS, IS and ES groups respectively. 

In summary, no significant difference was found among experience groups when comparing the rates of TURBT complications, the presence of DM in the specimen, need for a repeat TURBT, and evidence of recurrence at 3-month cystoscopy. Interestingly, patients treated by expert surgeons were more likely to experience complications and require a repeat TURBT. One wonders if these findings are related to the participation of residents in the TURBT, which has been shown to be a factor associated with the quality of TURBTs. Is it safe to assume that an expert surgeon is more likely to allow a resident perform a significant role in a case that a less experienced surgeon possibly contributing to results obtained. Another hypothesis is the adoption of bi-polar technology by younger surgeons which has been shown to decrease the risk of complication in patients undergoing TURBT. 

Presenter: Richard Naspro, MD (Bergamo Italy)

Written by: Andres F. Correa, MD Urologic Oncology, Fellow Fox Chase Cancer Center, Philadelphia, PA at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA

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