The presence of detrusor muscle (DM) is essential for accurate staging of T1 cancers. DM presence can be a quality indicator of transurethral resection of bladder tumor (TURBT) for NMIBC. We hypothesized that increasing surgeon awareness of personal and institutional DM sampling rates could improve resection quality and long-term oncologic outcomes.
A retrospective review of TURBTs from 1/2006 to 2/2018 was performed. The presence of DM in the pathology report and TUR specimen was extracted from records. Individual surgeon scorecards were created and distributed. Rates of DM sampling were compared prior to and 12 months after distribution. Chart review was done to compare 3-year recurrence and progression outcomes before and after distribution of scorecards.
The rate of DM sampling increased from 36% (1250/3488) to 54% (202/373) (p = 0.001) in the 12 months after scorecard distribution; from 30% (448/1500) to 55% (91/165) (p < 0.001) in Ta tumors and from 47% (183/390) to 72% (42/58) (p < 0.001) in T1 tumors. Pathologic reporting of muscle also improved: all samples (73% [2530/3488] to 90% [334/373], p < 0.001), Ta (75% [1127/1500] to 94% [155/165], p < 0.001), and T1 (93% [362/390] to 100% [58/58], p = 0.04). On multivariate Cox regression analysis, the surgeon scorecard was associated with decreased 3-year risk of recurrence (HR 0.63, 95%CI 0.40-0.99).
Creation and distribution of individual surgeon scorecards improved DM sampling on TUR and was associated with decreased risk of recurrence. Quality evaluation of TURBT may contribute to improved outcomes of patients with NIMBC.
The Journal of urology. 2020 Oct 06 [Epub ahead of print]
Arighno Das, Jason E Cohen, Oliver S Ko, Brian J Jordan, Alexander P Glaser, Gregory B Auffenberg, Joshua J Meeks
Department of Urology, Northwestern University Feinberg School of Medicine, Jesse Brown VAMC, Chicago, Illinois., Department of Urology, University of Washington, Seattle, Washington., Division of Urology, Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois.