Surgeon experience in second-look transurethral resection of bladder cancer - a prospective study

C N Fernandes; L Vale; J V Sousa; T Antunes-Lopes; C M Silva; J Silva

doi:10.1016/j.acuroe.2023.12.007

Surgeon experience in second-look transurethral resection of bladder cancer - a prospective study

Actas Urol Esp (Engl Ed). 2023 Dec 29:S2173-5786(23)00143-9. doi: 10.1016/j.acuroe.2023.12.007. Online ahead of print.

[Article in English, Spanish]

Authors

C N Fernandes¹, L Vale², J V Sousa³, T Antunes-Lopes², C M Silva², J Silva²

Affiliations

¹ Servicio de Urología, Hospital Universitario de São João, Oporto, Portugal. Electronic address: fernandes.claudia.med@gmail.com.
² Servicio de Urología, Hospital Universitario de São João, Oporto, Portugal; Facultad de Medicina, Universidad de Oporto, Oporto, Portugal.
³ Servicio de Urología, Hospital Universitario de São João, Oporto, Portugal.

PMID: 38160792
DOI: 10.1016/j.acuroe.2023.12.007

Abstract

Introduction and objectives: Transurethral resection of bladder tumor (TURBT) is crucial in the treatment of bladder tumors and when incorrectly performed can cause staging mistakes. To avoid these errors, a second resection is recommended in selected cases. The aim of this study is to evaluate the surgeon's ability to predict histologically complete primary resection of newly diagnosed bladder tumors avoiding the need for a second TURBT.

Methods: This is a prospective, observational study involving 47 consecutive patients with newly diagnosed bladder tumors who had previously undergone primary TURBT, and met EAU criteria for second-look TURBT. Second-look TURBT specimens were analyzed for routine histological assessment and compared with the surgeon's impression of the tumor at initial resection.

Results: Of 91 patients submitted to primary TURBT, 47 met the criteria for second-look TURBT. Second-look specimens revealed residual disease in 20.9% of patients and 3 (6.4%) of patients showed upstaging disease. The sensitivity of a senior to detect disease on second-look TURBT in relation to muscle invasion was 75%, and the specificity was 85%.

Conclusions: Second-look TURBT is crucial in the treatment of bladder cancer and cannot be replaced by a surgeon's opinion, so international recommendations should be followed. Supervision of less experienced surgeons is a cornerstone.

Keywords: Bladder detrusor muscle; Experiencia del cirujano; Músculo detrusor de la vejiga; Non-muscle invasive bladder neoplasms; Second-look surgery; Segunda cirugía; Surgeon experience; Tumor vesical no músculo-invasor.