OBJECTIVE: This study aimed to evaluate the impact of experience in transurethral resection of bladder tumour (TURBT) on recurrence and progression in primary Ta/T1 urinary bladder cancer. MATERIAL AND METHODS: Clinical and pathological characteristics of patients with primary Ta/T1 urinary bladder cancer were recorded prospectively from 1992 to 2007 inclusive. Data on surgeons' experience were categorized as follows: experience by training status (residents or specialists); number of TURBTs performed by each surgeon during the registration period, with cut-off levels at more than 100, more than 150, more than 200, greater than the median and above the third quartile of surgical volume; and lifetime high-volume surgeons (>100 TURBTs). Hazard ratios (HRs) were estimated using Cox regression with 95% confidence intervals (CIs) in multivariate analyses. RESULTS: The analysis included 768 evaluable patients with a median follow-up of 60 months. Recurrence was observed in 478 patients (62%) and progression in 71 (9%). Surgery was performed by residents in 100 cases and specialists in 668, with recurrence in 75 (75%) and 403 (60%) patients, and progression in nine (9%) and 62 (9%), respectively. Surgery performed by specialists was significantly associated with a lower recurrence rate (HR = 0.68, 95% CI 0.53-0.87) but not progression (HR = 0.76, 95% CI 0.37-1.56). Surgical volume had no significant impact on recurrence or progression in any of the analyses at the chosen cut-offs. CONCLUSIONS: Surgical experience (specialist/resident) was predictive for recurrence after TURBT for Ta/T1 bladder cancer. Training programmes, checklists and specialist-assisted surgery may shorten the learning curve and improve results.
OBJECTIVE: This study aimed to evaluate the impact of experience in transurethral resection of bladder tumour (TURBT) on recurrence and progression in primary Ta/T1 urinary bladder cancer. MATERIAL AND METHODS: Clinical and pathological characteristics of patients with primary Ta/T1 urinary bladder cancer were recorded prospectively from 1992 to 2007 inclusive. Data on surgeons' experience were categorized as follows: experience by training status (residents or specialists); number of TURBTs performed by each surgeon during the registration period, with cut-off levels at more than 100, more than 150, more than 200, greater than the median and above the third quartile of surgical volume; and lifetime high-volume surgeons (>100 TURBTs). Hazard ratios (HRs) were estimated using Cox regression with 95% confidence intervals (CIs) in multivariate analyses. RESULTS: The analysis included 768 evaluable patients with a median follow-up of 60 months. Recurrence was observed in 478 patients (62%) and progression in 71 (9%). Surgery was performed by residents in 100 cases and specialists in 668, with recurrence in 75 (75%) and 403 (60%) patients, and progression in nine (9%) and 62 (9%), respectively. Surgery performed by specialists was significantly associated with a lower recurrence rate (HR = 0.68, 95% CI 0.53-0.87) but not progression (HR = 0.76, 95% CI 0.37-1.56). Surgical volume had no significant impact on recurrence or progression in any of the analyses at the chosen cut-offs. CONCLUSIONS: Surgical experience (specialist/resident) was predictive for recurrence after TURBT for Ta/T1 bladder cancer. Training programmes, checklists and specialist-assisted surgery may shorten the learning curve and improve results.
Authors: Anna H de Vries; Arno M M Muijtjens; Hilde G J van Genugten; Ad J M Hendrikx; Evert L Koldewijn; Barbara M A Schout; Cees P M van der Vleuten; Cordula Wagner; Irene M Tjiam; Jeroen J G van Merriënboer Journal: Surg Endosc Date: 2018-06-05 Impact factor: 4.584
Authors: Lukasz Bialek; Slawomir Poletajew; Piotr Maciej Magusiak; Mikolaj Ostrach; Jakub Szpernalowski; Bartosz Dybowski; Piotr Radziszewski Journal: Turk J Urol Date: 2018-11-21
Authors: Jonathan Moore; Stewart Whalen; Neal Rowe; Jason Y Lee; Michael Ordon; Andrea G Lantz Powers Journal: Can Urol Assoc J Date: 2022-04 Impact factor: 1.862
Authors: Seung Bin Kim; Sung Goo Yoon; Jonghyun Tae; Jae Yoon Kim; Ji Sung Shim; Sung Gu Kang; Jun Cheon; Jeong Gu Lee; Je Jong Kim; Seok Ho Kang Journal: Investig Clin Urol Date: 2018-02-08