Is TURBT able to cure high risk recurrent superficial or muscle invasive bladder cancer: Factors resulting in pT0 radical cystectomy specimens

Abstract

Purpose: In 76% of radical cystectomy patients there is discrepancy between the initial stage at transurethral resection and the final pathological stage of the cystectomy specimen. More specifically in contemporary series the absence of tumor at radical cystectomy specimens (stage pT0) is estimated at 5-25%. Our aim was to determine which factors contributed to the absence of tumor in our series of radical cystectomy patients. Materials and Methods: Fifty one patients were submitted to radical cystectomy in our department over the last 10 years (January 2002-January 2012). A thorough analysis of the patients' files with no residual tumor on the cystectomy specimen (pT0) was performed. Possible factors contributing to such a result were described and a systematic analysis of the relevant literature was performed. Results: Five patients had a pT0 stage after radical cystectomy. Four of them had transitional cell carcinoma and one of them had squamous cell carcinoma of the bladder on the initial transurethral resection. None of the tumors presented lymphovascular invasion. Four patients are still alive and one died 45 months postoperatively from a cardiac cause. Conclusions: Four factors were identified in our study to contribute towards a pT0 cystectomy result. Those included the absence of lymphovascular invasion, the completeness of transurethral resection, the experience of the surgeon and the use of a standardized technique for the transurethral resection. The time to cystectomy in our series did not have a negative effect on pT0 final pathology result.

Outcomes and Prognostic Factors of Patients with Urothelial Carcinoma Undergoing Radical Cystectomy and pT0 in the Final Histology Without Neoadjuvant Chemotherapy

“…Moreover, it has been observed that the time from TURB to RC does not impact pT0 rates. 24 Achieving pT0 might depend on prior radical transurethral resection of the tumor, rather than prior intravesical treatment or time between TURB and RC. Further, the use of advanced imaging technologies during cystoscopy such as PDD did not affect outcomes of patients.…”

“…Surgeon´s experience, and conducting standardized TURB procedures and completeness of TURB have been demonstrated to contribute to pT0 rates in RC. 24 However, absence of tumor in the last TURB prior RC does not necessarily predict pT0 in the final histology after RC 25 and therefore impacts bladder-preserving strategies in this setting.…”