Adam Kinnaird1, Peter Dromparis2, Howard Evans1. 1. Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada. 2. Department of Pathology, University of Alberta, Edmonton, AB, Canada.
Abstract
INTRODUCTION: Non-muscle-invasive bladder cancer is the most expensive malignancy to treat. Current Canadian guidelines recommend repeat transurethral resection of bladder tumour (TURBT) within six weeks after initial resection of T1 high-grade (T1HG) urothelial carcinoma, prior to initiation of intravesical bacillus Calmette-Guerin treatment. This is a burden on operating room usage and adds further cost and risk of complications. Internationally, major cancer centres report significant rates of recurrence and upstaging on repeat resection, however, minimal Canadian data is available. We aimed to determine the rate of recurrence and upstaging in a resource-limited, Canadian healthcare system. METHODS: A retrospective review of patients receiving TURBT between November 2009 and November 2014 was performed. Patients were included if they had all three of the following: a pathological diagnosis of T1HG, adequate muscularis propria present in the specimen, and a repeat resection. RESULTS: We reviewed 3166 patients who underwent TURBT and found 173 to meet our inclusion criteria. The overall recurrence and upstaging rates were 57.2% and 9.2%, respectively. Tumour recurrence and upstaging occurred more often in patients who had repeat resection after 12-24 weeks compared to those patients whose repeat resection occurred within 12 weeks. CONCLUSIONS: Although recurrence rates are similar, we have found upstaging rates to be three- to four-fold lower than those previously reported. Despite this, one in 10 patients will be upstaged, justifying use of this resource within our healthcare system. Finally, timely repeat resection, within 12 weeks appears to be associated with preventing disease progression.
INTRODUCTION: Non-muscle-invasive bladder cancer is the most expensive malignancy to treat. Current Canadian guidelines recommend repeat transurethral resection of bladder tumour (TURBT) within six weeks after initial resection of T1 high-grade (T1HG) urothelial carcinoma, prior to initiation of intravesical bacillus Calmette-Guerin treatment. This is a burden on operating room usage and adds further cost and risk of complications. Internationally, major cancer centres report significant rates of recurrence and upstaging on repeat resection, however, minimal Canadian data is available. We aimed to determine the rate of recurrence and upstaging in a resource-limited, Canadian healthcare system. METHODS: A retrospective review of patients receiving TURBT between November 2009 and November 2014 was performed. Patients were included if they had all three of the following: a pathological diagnosis of T1HG, adequate muscularis propria present in the specimen, and a repeat resection. RESULTS: We reviewed 3166 patients who underwent TURBT and found 173 to meet our inclusion criteria. The overall recurrence and upstaging rates were 57.2% and 9.2%, respectively. Tumour recurrence and upstaging occurred more often in patients who had repeat resection after 12-24 weeks compared to those patients whose repeat resection occurred within 12 weeks. CONCLUSIONS: Although recurrence rates are similar, we have found upstaging rates to be three- to four-fold lower than those previously reported. Despite this, one in 10 patients will be upstaged, justifying use of this resource within our healthcare system. Finally, timely repeat resection, within 12 weeks appears to be associated with preventing disease progression.
Authors: Wassim Kassouf; Ashish M Kamat; Alexander Zlotta; Bernard H Bochner; Ronald Moore; Alan So; Jonathan Izawa; Ricardo A Rendon; Louis Lacombe; Armen G Aprikian Journal: Can Urol Assoc J Date: 2010-06 Impact factor: 1.862
Authors: Elenir B C Avritscher; Catherine D Cooksley; H Barton Grossman; Anita L Sabichi; Lois Hamblin; Colin P Dinney; Linda S Elting Journal: Urology Date: 2006-09-18 Impact factor: 2.649
Authors: Richard J Sylvester; Adrian P M van der Meijden; Willem Oosterlinck; J Alfred Witjes; Christian Bouffioux; Louis Denis; Donald W W Newling; Karlheinz Kurth Journal: Eur Urol Date: 2006-01-17 Impact factor: 20.096