To address the association of perioperative surgical checklist across variable surgical expertise with transurethral resection of bladder tumor (TURBT) accuracy and oncologic outcomes in non-muscle invasive bladder cancer (NMIBC).
we relied on our prospective collaborative database of patients treated with TURBT between 2012 and 2017. Surgical experience was stratified into three groups: resident vs young vs expert consultants. The association of surgical experience with detrusor muscle (DM) presence and adherence to the standardized peri-procedural 9-items TURBT checklist was evaluated with logistic regression models. A Cox regression model was used to investigate the association of surgical experience with recurrence-free survival (RFS).
A total of 503 patients were available for analysis. TURBT was performed by expert consultants in 265 (52.7%) patients, by young consultants in 149 patients (29.6%) and by residents in 89 patients (17.7%). Residents were more likely to have DM in the TURBT specimen than expert consultants (OR: 1.75, 95%CI 1.03-2.99, p=0.04). Conversely, no differences in DM presence were observed between young vs expert consultants (OR: 1.09, 95%CI 0.71-1.70, p=0.69). The median checklist completion rate was higher for both residents and young consultants when compared to experts counterparts (56% and 56% vs 44%, p=0.009). When focusing on patients receiving a 2nd look TURBT, the persistent disease was associated with resident status (OR: 4.24, 95%CI 1.14-17.70, p=0.037) at initial TURBT. Surgical experience was not associated with 5-years RFS.
Surgeon's experience in case of adequate perioperative surgical checklist implementation was inversely associated with the presence of DM in the specimen but directly linked to higher probability of persistent disease at Re-TURBT, although no 5-yr RFS differences were noted.
BJU international. 2022 Oct 17 [Epub ahead of print]
Francesco Del Giudice, David D'Andrea, Benjamin Pradere, Florian Berndl, Maximilian Pallauf, Rocco Simone Flammia, Dominik Philipp, Marco Moschini, Andrea Mari, Simone Albisinni, Wojciech Krajewski, Ekaterina Laukhtina, Andrea Gallioli, Laura S Mertens, Gautier Marcq, Alessia Cimadamore, Luca Afferi, Paolo Gontero, Shahrokh F Shariat, Benjamin I Chung, Francesco Soria
Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Department of Urology, San Raffaele Hospital and Scientific Institute, Milan, Italy., Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy., Urology Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium., Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland., Fundacio Puigvert, 16444, Urology, Barcelona, Catalunya, Spain., Department of urology, the Netherlands Cancer Institute, Amsterdam, the Netherlands., Urology Department, Claude Huriez Hospital, CHU Lille, F-59000, Lille, France., Section of Pathological Anatomy, School of Medicine, Polytechnic University of the Marche Region, United Hospitals, Ancona, Italy., Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland., Urology Division, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy., Department of Urology, Stanford University School of Medicine, Stanford, USA, CA.