Surgical checklist impact on recurrence-free survival of patients with non-muscle-invasive bladder cancer undergoing transurethral resection of bladder tumour.

OBJECTIVES:

To evaluate the impact of an eight-item surgical checklist (SC) on the recurrence-free survival (RFS) of patients with non-muscle-invasive bladder cancer (NMIBC) undergoing transurethral resection of bladder tumour (TURBT).

PATIENTS AND METHODS:

A group of urologists at two tertiary referral centres, with expertise in bladder cancer, identified eight critical items that should be performed in every high-quality TURBT. An eight-item SC was prospectively implemented into clinical practice and the operative reports of TURBTs performed before and after implementation were reviewed. Results from both institutions were combined to estimate the impact of introducing the SC on oncological outcomes. Multivariable logistic and Cox hazards regression analyses were performed to evaluate the impact of the SC on the presence of detrusor muscle in the TURBT specimen and on RFS, respectively.

RESULTS:

The operative reports of 266 TURBTs performed after the SC implementation were reviewed and compared to those of 281 TURBTs performed prior to the SC introduction. The SC was independently associated with a significant improvement in RFS (P = 0.02). However, the introduction of the SC was not significantly associated with the presence of detrusor muscle in the surgical specimen (P = 0.4).

CONCLUSION:

The use of an eight-item SC during TURBT in clinical practice increases the quality of operative reports thereby potentially improving individualised risk-stratification and care resulting in lower disease recurrence rates. Therefore, the introduction of a SC can be recommended to enhance oncological outcomes by improving surgical standardisation and operative reporting.

BJU Int. 2019 Apr;123(4):646-650. doi: 10.1111/bju.14557. Epub 2018 Oct 23.

Suarez-Ibarrola R1, Soria F1,2, Abufaraj M1,3, D'Andrea D1, Preto M2, Gust KM1,4, Briganti A5, Shariat SF1,4,6,7, Gontero P2.

1Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
2Division of Urology, University of the Studies of Turin, AOU Città della Salute e della Scienza di Torino Presidio Molinette, Turin, Italy.
3Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan.
4Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
5Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
6Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.
7Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.

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