[T1 bladder tumors: value of a second endoscopic resection].

OBJECTIVE: To quantify the percentage of residual tumour following systematic second endoscopic resection of pT1 bladder tumours before starting treatment with intravesical instillations and to definitively exclude muscle invasion.
MATERIAL AND METHODS: From January 1995 to December 1999, 52 patients with a first diagnosis of pT1 bladder tumour underwent a second endoscopic resection 3 to 5 weeks later. Nine surgeons, 5 seniors and 4 juniors, managed these patients and the initial resection was considered to be complete in every case. The second resection consisted of resection of the initial tumour bed and distant biopsies either directed to zones of suspicious CIS zones or quadrant biopsies in the case of optically healthy mucosa.
RESULTS: Of the 52 included patients, 19 (36.5%) had residual disease on the second endoscopic resection. Pathological staging was: pT0 = 63.5% (33 patients), pTa = 11.5% (6 patients), pTis = 3.85% (2 patients), pT1 = 17.3% (9 patients), > or = pT2 = 3.85% (2 patients). Residual tumour tissue was revealed at the resection site in 84.2% of cases and in another site in 15.8% of cases. Residual tumour was significantly more frequent in the case of multifocal tumour than in the case of solitary tumour (57.9% vs 24.23%), and when managed by a junior surgeon compared to a senior surgeon (53.8% vs 30.8%).
CONCLUSION: This second endoscopic procedure appears to be essential to ensure the absence of residual tumour before starting conservative treatment for pT1 bladder tumours.