UroToday.com - This presentation addressed the issue that recurrence at first follow-up cystoscopy (RR-FFC) after TURBT has been attributed to incomplete resection of the tumor. Furthermore, an EORTC analysis of multicenter trials suggested the inter-institutional variability of RR-FFC was a result of variable TURBT 'quality'. Dr. Mariappan and members of the Edinburgh Uro-Oncology Group aimed to determine if (a) detrusor muscle can be a surrogate marker of this 'quality' and (b) the presence of detrusor is dependant on surgeon's experience.
The researchers reviewed their prospectively maintained database of patients with newly diagnosed bladder tumors in 2005-2006, to determine surgeon status, tumor characteristics and RR-FFC. Only patients with complete resections as determined by the surgeon were included. For analysis, surgeons were stratified into (a) seniors (consultant and Year 5 or 6 trainees) and (b) juniors (trainees < year 5). One investigator, blinded to the above characteristics, interrogated our pathology database to confirm histological tumor grade, stage and detrusor muscle status. Logistic regression analysis was carried out.
A total of 356 patients were suitable for analysis. The majority of tumors in this cohort were small (73.3%), single (84.6%) and high grade (48.3%). Seniors performed 66.1% of the resections. Overall, detrusor muscle was present in 241 (67.7%) of resections. Logistic regression multivariate analysis revealed large tumors, high grade tumors and surgery carried out by senior surgeons were associated with presence of detrusor (Table 1). The overall RR-FFC was 26.8%. The risk of early recurrence following TURBT was 35.9% and 21.5% when detrusor muscle was absent and present, respectively (OR=2.1, 95%CI=1.1-4, p=0.02). Dr. Mariappan concluded that the presence of detrusor muscle in the TURBT specimen was more likely when surgery was performed by senior surgeons and this predicted a lower RR-FFC. This parameter appears to be a surrogate marker of the quality of TURBT.
Presented by: P. Mariappan, MD, et al, at the European Association of Urology - 23rd Annual EAU Congress - March 26 - 29, 2008 - Milan, Italy
Reported by UroToday.com Contributing Editor, Christopher P. Evans, MD
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