Do repeated transurethral procedures under general anesthesia influence mortality in patients with non-invasive urothelial bladder cancer? A Danish national cohort study

Erikson, Marie Schmidt; Petersen, Astrid; Andersen, Klaus Kaae; Jacobsen, Frederik Krogsdal; Mogensen, Karin; Hermann, Gregers G.

doi:10.1080/21681805.2020.1782978

Cited by 12 publications

(11 citation statements)

References 25 publications

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“…16,[18][19][20]23 In addition, recently published evidence suggests that repetitive TURBT is independently associated with an increased mortality risk. 17 Finally, the repeated use of general anesthesia in the elderly may predispose to cognitive decline. 24,25 Studies of aqueous preparations of mitomycin suggest that chemoablation with mitomycin may obviate the need for surgery in some patients or reduce the perioperative morbidity associated with surgery secondary to lower volume disease, and may be associated with fewer clinically significant adverse effects.…”

Section: Discussionmentioning

confidence: 99%

“… 16 , 18 – 20 , 23 In addition, recently published evidence suggests that repetitive TURBT is independently associated with an increased mortality risk. 17 Finally, the repeated use of general anesthesia in the elderly may predispose to cognitive decline. 24 , 25 …”

Section: Discussionmentioning

confidence: 99%

“…14 Therefore, patients with LG IR NMIBC are most commonly managed by repetitive TURBTs under general anesthesia with its attendant risks. [15][16][17][18][19][20][21] UGN-102 is an investigational agent designed for primary nonsurgical treatment of LG IR NMIBC, and to potentially obviate the need for repetitive TURBT. UGN-102 consists of mitomycin and a proprietary reverse thermal hydrogel (UroGen Pharma, Ra'anana, Israel) used to reconstitute mitomycin before instillation.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Primary Chemoablation of Low-Grade Intermediate-Risk Nonmuscle-Invasive Bladder Cancer Using UGN-102, a Mitomycin-Containing Reverse Thermal Gel (Optima II): A Phase 2b, Open-Label, Single-Arm Trial

et al. 2022

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Primary Chemoablation of Low-Grade Intermediate-Risk Nonmuscle-Invasive Bladder Cancer Using UGN-102, a Mitomycin-Containing Reverse Thermal Gel (Optima II): A Phase 2b, Open-Label, Single-Arm Trial

et al. 2022

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“…Two reports hypothesize that repeated diagnostic or therapeutic transurethral procedures for local recurrences in individuals with NMIBC are associated with increased risk of death of causes other than bladder cancer. They found an inferior relative survival in individuals with NMIBC compared to a background population [1] and a higher risk of death associated with the number of transurethral resections [2]. If repeated interventions requiring anaesthesia in a group with many frail individuals iatrogenically causes deaths, this would necessitate not only a review of follow-up routines for NMIBC but also of other follow-up programs that include repeated anaesthesia.…”

Section: Introductionmentioning

confidence: 99%

Number of transurethral procedures after non-muscle-invasive bladder cancer and survival in causes other than bladder cancer

et al. 2022

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Background Previous research has associated repeated transurethral procedures after a diagnosis of non-muscle invasive bladder cancer (NMIBC) with increased risk of death of causes other than bladder cancer. Aim We investigated the overall and disease-specific risk of death in patients with NMIBC compared to a background population sample. Methods We utilized the database BladderBaSe 2.0 containing tumor-specific, health-related and socio-demographic information for 38,547 patients with NMIBC not primarily treated with radical cystectomy and 192,733 individuals in a comparison cohort, matched on age, gender, and county of residence. The cohorts were compared using Kaplan-Meier curves and Hazard ratios (HR) from a Cox regression models. In the NMIBC cohort, we analyzed the association between number of transurethral procedures and death conditioned on surviving two or five years. Results Overall survival and survival from causes other than bladder cancer estimated with Kaplan-Meier curves was 9.3% (95% confidence interval (CI) (8.6%-10.0%)) and 1.4% (95% CI 0.7%-2.1%) lower respectively for the NMIBC cohort compared to the comparison cohort at ten years. In a Cox model adjusted for prognostic group, educational level and comorbidity, the HR was 1.03 (95% CI 1.01–1.05) for death from causes other than bladder cancer comparing the NMIBC cohort to the comparison cohort. Among the NMIBC patients, there was no discernible association between number of transurethral procedures and deaths of causes other than bladder cancer after adjustment. The number of procedures were, however, associated with risk of dying from bladder cancer HR 3.56 (95% CI 3.43–3.68) for four or more resections versus one within two years of follow-up. Conclusion The results indicate that repeated diagnostic or therapeutic transurethral procedures under follow-up do not increase of risk dying from causes other than bladder cancer. The modestly raised risk for NMIBC patients dying from causes other than bladder cancer is likely explained by residual confounding.

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“…First, in a population where most patients are older than 65 years and frailty exceeds 10%, a 5% complication rate at transurethral resection of bladder tumor (TURBT) may be considered overtreatment, especially for iterative resections of small recurrent lesions [7][8][9][10][11][12]. In addition, anesthesia-related complications are higher in this population and are associated with longer-term morbidity and mortality [13,14]. Therefore, avoiding overtreatment in an elderly frail patient with limited life expectancy, particularly when the oncological risk of progression is low, is certainly a reasonable treatment option.…”

Section: Introductionmentioning

confidence: 99%

Active surveillance for non-muscle-invasive bladder cancer: fallacy or opportunity?

Deimling

Pallauf

Bianchi

et al. 2022

Current Opinion in Urology

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Purpose of reviewThis review aims to analyze the current place of active surveillance (AS) in non-muscle-invasive bladder cancer (NMIBC).Recent findingsA growing body of evidence suggests that AS protocols for pTa low-grade (TaLG) NMIBC are safe and feasible. However, current guidelines have not implemented AS due to a lack of high-quality data. Available studies included pTa tumors, with only one study excluding pT1-NMIBC. Inclusion/exclusion criteria were heterogeneously defined based on tumor volume, number of tumors, carcinoma in situ (CIS), or high-grade (HG) NMIBC. Tumor volume <10 mm and <5 lesions were used as cut-offs. Positive urinary cytology (UC) or cancer-related symptoms precluded inclusion. Surveillance within the first year consisted of quarterly cystoscopy. AS stopped upon the presence of cancer-related symptoms, change in tumor morphology, positive UC, or patient's request. With a median time on AS of 16 months, two-thirds of the patients failed AS. Progression to muscle-invasive bladder cancer (MIBC) was rare and occurred only in patients with pT1-NIMBC at inclusion.SummaryAS in NMIBC is an attractive concept in the era of personalized medicine, but strong evidence is still awaited. A more precise definition of patient inclusion, follow-up, and failure criteria is required to improve its implementation in daily clinical practice.

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Do repeated transurethral procedures under general anesthesia influence mortality in patients with non-invasive urothelial bladder cancer? A Danish national cohort study

Cited by 12 publications

References 25 publications

Primary Chemoablation of Low-Grade Intermediate-Risk Nonmuscle-Invasive Bladder Cancer Using UGN-102, a Mitomycin-Containing Reverse Thermal Gel (Optima II): A Phase 2b, Open-Label, Single-Arm Trial

Primary Chemoablation of Low-Grade Intermediate-Risk Nonmuscle-Invasive Bladder Cancer Using UGN-102, a Mitomycin-Containing Reverse Thermal Gel (Optima II): A Phase 2b, Open-Label, Single-Arm Trial

Number of transurethral procedures after non-muscle-invasive bladder cancer and survival in causes other than bladder cancer

Active surveillance for non-muscle-invasive bladder cancer: fallacy or opportunity?

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