An European Organisation for Research and Treatment of Cancer analysis of multicentre
trials found significant interinstitutional variability in recurrence rates at first
follow-up cystoscopy (RR-FFC) and attributed this to variable transurethral resection
of bladder tumour (TURBT) quality.
To determine whether resection of detrusor muscle (DM) in the first, apparently complete
TURBT is a surrogate marker of quality and whether the presence of DM is dependent
on a surgeon's experience.
Over a 2-yr period, patients with new bladder tumours that were judged to have been
completely resected were recruited from our prospectively maintained bladder tumour
database. Strict exclusion criteria were applied.
Prospectively recorded tumour size, tumour multiplicity, surgeon category, DM status,
grade and stage of tumour, and findings at first follow-up cystoscopy (at 3 mo) and
at early re-TURBT were evaluated. Surgeons were stratified into seniors (consultants
and year 5 or year 6 trainees) and juniors (trainees lower than year 5). Early recurrence
(for calculating RR-FFC) was defined as pathologically confirmed tumour on early re-TURBT
or recurrence at the first follow-up cystoscopy. Logistic regression multivariate
analyses were carried out to determine associations between variables.
In a total of 356 patients, DM was present in 241 patients (67.7%). Multivariate analyses
revealed that large tumours, high-grade tumours, and surgery by senior surgeons was
independently associated with the presence of DM in the resected specimens. The RR-FFCs
when DM was absent and present were 44.4% and 21.7%, respectively (odds ratio: 2.9;
95% confidence interval: 1.6-5.4; p=0.0002). The absence of DM and resection by less
experienced surgeons independently predicted a higher RR-FFC. This association was
also seen in small and low-grade tumours. The number of patients in this study appears
modest, and further validation may be required.
DM absence or presence in the first, apparently complete TURBT specimen appears to
be a surrogate marker of resection quality by independently predicting the RR-FFC,
which is also dependent on surgeon experience.
Copyright © 2009 European Association of Urology. Published by Elsevier B.V. All rights