Original Research Paper

Role Of Restage Transuretheral Resection Of Bladder Tumor In High Risk Non Muscle Invasive Bladder Cancer

Abstract :

BackgroundTransurethral resection of the bladder tumor (TURBT) is the treatment of choice and gold standard for the treatment of clinical non-muscle invasive bladder cancer. Incomplete resection, tumor cell re-implantation, presence of subclinical tumors lead to recurrence of bladder cancer. According to guideline recommendations, restage TURBT is indicated 2-6 weeks after the initial TURBT in high-risk patients. The objective of the present study was undertaken to evaluate role of restage TURBT in high risk non-muscle invasive bladder cancer (NMIBC).ObjectiveTo identify the category of patients with high risk non-muscle invasive bladder cancer who may benefit from a routine restage TURBT procedure.Materials and MethodsIn this prospective observational study, biopsy proven NMIBC patients with gross total painless hematuria secondary to urinary bladder mass from October 2017 to June 2019 were enrolled. Patients with high risk disease on primary TURBT underwent re-TURBT within 2-6 weeks of primary procedure. Residual/ recurrent disease and tumor upstaging were recorded. Logistic regression analysis were used to explore risk factors associated with residual/recurrent disease and tumor upstaging during re-TURBT. ResultsA total of 250 patients (deep muscle involvement, n=237 and no muscle involvement, n=13) with histopathologically confirmed high risk disease following re-TURBT were included in the final analysis. During re-TURBT, 18% patients had residua or recurrent tumor. Presence of upper tract changes, presence of perivesical fat stranding and tumor size > 3cm, high grade histopathology and positive urine for malignant cytology were significantly associated with risk of residual or recurrent disease. Absence of muscle in primary TURBT specimen, presence of recurrent/residual growth in re-TURBT specimen, bladder tumor antigen increased the risk of upstaging. ConclusionDespite the low recurrence rate of tumor in re-TURBT, reTURBT within 2-6 weeks of primary TURBT is an essential step for the accurate diagnosis among NMIBC patients. This further aids in deciding the subsequent treatment step in patients with upstaging and recurrent/ residual tumor.

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