Do we need repeat transurethral resection after en bloc resection for pathological T1 bladder cancer?

Abstract

To assess the clinical significance of repeat transurethral resection (reTUR) and surgical margin status after en bloc resection of bladder tumour (ERBT) for pathological T1 (pT1) bladder cancer. Patients and MethodsWe retrospectively analysed the record of 106 patients with pT1 high-grade bladder cancer who underwent ERBT between April 2013 and February 2021 at multiple institutions. All specimens were reviewed by a genitourinary pathologist. The primary outcome measures were recurrence-free survival (RFS) and progression-free survival (PFS) between patients with and those without reTUR. We also analysed the predictive value of surgical margin on the likelihood of residual tumour on reTUR. ResultsA reTUR was performed in 50 of the 106 patients. The 2-year RFS and 3-year PFS were comparable between patients who underwent reTUR and those who did not (55.1% vs 59.9%, P = 0.6, 80.6% vs 82.6%, P = 0.6, respectively). No patient was upstaged to pT2 on reTUR. Regarding the surgical margin status, there were no recurrences at the original site in 51 patients with negative horizontal margins. Cox proportional hazard analysis revealed that a positive vertical margin was an independent prognostic factor of worse PFS. On reTUR, six pTa/is residues were detected in patients with a positive horizontal margin, and three pT1 residues were detected in one patient with a positive vertical margin or other adverse pathological features. ConclusionsA reTUR after ERBT for pT1 bladder cancer appears not to improve either recurrence or progression. Surgical margin status affects prognosis and reTUR outcomes. A reTUR can be omitted after ERBT in patients with pT1 bladder cancer and negative margins; for those with positive horizontal or vertical margins, reTUR should remain the standard until proven otherwise.

The impact of second transurethral resection on survival outcomes in patients with non-muscle-invasive bladder cancer treated with bacillus Calmette–Guérin therapy

“…Yanagisawa et al. ( 16 ) also recently reported that second TUR after en bloc resection of bladder tumour for pT1 bladder cancer could not improve either recurrence or progression. Taken together with their observations, we should keep in mind that high-quality TUR, which means it includes the muscularis propria for accurate disease staging and disease eradication by meticulous procedures, is mandatory before bladder preservation treatment.…”

Letter to the editor regarding the article ‘Do we need repeat transurethral resection after en bloc resection for pathological T1 bladder cancer?

“…We read with great interest the Letter to the Editor by Besiroglu regarding our manuscript entitled, 'Do we need repeat transurethral resection after en bloc resection for pathological T1 bladder cancer?' [1]. Besiroglu pointed out that our findings should be translated to clinical practice with caution because of several methodological and statistical shortcomings.…”

“…We read the current paper entitled 'Do we need repeat transurethral resection after en bloc resection for pathological T1 bladder cancer?' [1]. The authors retrospectively evaluated the multi-institutional data of patients with non-muscle-invasive bladder cancer.…”

Recent advancements in the diagnosis and treatment of non‐muscle invasive bladder cancer: Evidence update of surgical concept, risk stratification, and BCG‐treated disease

“…However, Yanagisawa et al. suggested surgical margin status on initial EBTUR could affect the prognosis of HG T1 BCa 21 . This data would recommend repeat TUR should be performed as the standard of care for patients with positive horizontal or vertical margins on initial EBTUR, but repeat TUR can be omitted for patients without positive surgical margins.…”

“…Because most evidence supporting the benefits of repeat TUR is based on data from conventional TURBT, another clinical concern is the role of repeat TUR after the initial EBTUR for NMIBC. Two recent papers concluded that repeat TUR after initial EBTUR does not improve staging accuracy, recurrence, or progression 20,21 . However, Yanagisawa et al.…”