The impact of completeness of last transurethral resection of bladder tumors on the outcomes of radical cystectomy.

To evaluate the role of a complete transurethral resection of bladder tumors (c-TURBT) on oncological outcomes after radical cystectomy (RC) and its relationship with adverse pathological features.

We retrospectively analyzed data of 727 patients treated with RC and bilateral pelvic lymph node dissection at three tertiary referral centers. Possible c-TURBT was reported by the treating surgeon. Multivariable Cox regression analyses were used to assess the relationship of c-TURBT and survival outcomes after surgery in 1:1 propensity score-matched cohort adjusted for age and gender. Moreover, multivariable logistic regression (MVA) was built to predict the relationship between c-TURBT and pT3-T4 stages at RC, lymph node invasion (LNI) and positive soft tissue surgical margin (STSM).

A total of 433 (60%) patients received a c-TURBT. 3.0% of patients with a c-TURBT achieved a pT0-pTa-pTis status vs. 2.0% of patients with incomplete TURBT. At multivariable Cox regression analyses, c-TURBT was not associated with survival outcomes. At MVA, incompleteness of TURBT was significantly associated with a pT3-T4 stage [odds ratio (OR) 8.04, 95% confidence interval (CI) 2.33-27.67, p = 0.001]. No significant association was found between c-TURBT, LNI and STSM.

We found a low rate of achievement of pT0 stage at RC. An incomplete TURBT before RC represented a predictor of pT3-T4 stages, but no effect of a c-TURBT was shown on survival outcomes. Given the current inadequacy of clinical staging strategies with more than 50% of extravesical disease being under-staged, our results could improve patients selection for NAC, driving the decision-making in doubtful cases.

World journal of urology. 2019 Mar 25 [Epub ahead of print]

Stefania Zamboni, Marco Moschini, Andrea Gallina, Renzo Colombo, Francesco Montorsi, Alberto Briganti, Andrea Salonia, Alessandro Antonelli, Claudio Simeone, Sandra Belotti, Luca Cristinelli, Agostino Mattei, Philipp Baumeister

Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland. ., Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland., Unit of Urology, Division of Oncology, IRCCS Ospedale San Raffaele, URI Milan, Milan, Italy., Urology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy.