SIU 2017: Are We Subjecting Too Many Patients to an Early Re-Resection?

Lisbon, Portugal (  Early TURBT re-resection is recommended for incomplete primary resections, large or multiple tumours, the presence of high-grade disease, or the absence of muscle in the specimen. Current evidence in high-grade disease shows residual disease in 33-53%, with upstaging to muscle-invasive disease in 4-25%. The objective of the authors in this study was to investigate patients diagnosed with high-grade bladder cancer with muscle in the specimen, and assess if they may benefit more from commencing intravesical BCG over early re-resection.

In this study, 94 patients were found to have high-grade disease on their first resection between January 2014 and July 2016. Retrospective data was collected on initial resection, re-resection, and treatment.

Forty three patients (46%) had muscle in their first resection. Twenty two patients (23%) had concomitant carcinoma-in-situ. Seventy seven patients (82%) had an early re-resection. Four patients (4.3%) were upstaged to muscle invasive bladder cancer; 2 had concomitant carcinoma-in-situ and lacked muscle in the first resection, 1 lacked muscle, and 1 had an incomplete resection. Forty patients (52%) had residual tumour on re-resection. Eight out of seventeen patients had no residual disease when muscle was in the primary resection and re-resection was completed within 8 weeks compared with 11/22 when muscle was present and re-resection was delayed beyond 8 weeks.

The authors conclude that in their center under-staging was rare. Therefore, the authors suggest that not all patients require an early re-resection. Further sub-classification of high-grade disease based upon multi-disciplinary discussion of operative and histological findings would enable optimisation of treatment in this group of patients.

Presented by: Brophy T. 
Affiliation: Royal Preston Hospital, Preston, United Kingdom

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre.Twitter: @GoldbergHanan at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal