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The impact of completeness of last transurethral resection of bladder tumors on the outcomes of radical cystectomy

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Abstract

Purpose

To evaluate the role of a complete transurethral resection of bladder tumors (c-TURBT) on oncological outcomes after radical cystectomy (RC) and its relationship with adverse pathological features.

Methods

We retrospectively analyzed data of 727 patients treated with RC and bilateral pelvic lymph node dissection at three tertiary referral centers. Possible c-TURBT was reported by the treating surgeon. Multivariable Cox regression analyses were used to assess the relationship of c-TURBT and survival outcomes after surgery in 1:1 propensity score-matched cohort adjusted for age and gender. Moreover, multivariable logistic regression (MVA) was built to predict the relationship between c-TURBT and pT3–T4 stages at RC, lymph node invasion (LNI) and positive soft tissue surgical margin (STSM).

Results

A total of 433 (60%) patients received a c-TURBT. 3.0% of patients with a c-TURBT achieved a pT0–pTa–pTis status vs. 2.0% of patients with incomplete TURBT. At multivariable Cox regression analyses, c-TURBT was not associated with survival outcomes. At MVA, incompleteness of TURBT was significantly associated with a pT3–T4 stage [odds ratio (OR) 8.04, 95% confidence interval (CI) 2.33–27.67, p = 0.001]. No significant association was found between c-TURBT, LNI and STSM.

Conclusion

We found a low rate of achievement of pT0 stage at RC. An incomplete TURBT before RC represented a predictor of pT3–T4 stages, but no effect of a c-TURBT was shown on survival outcomes. Given the current inadequacy of clinical staging strategies with more than 50% of extravesical disease being under-staged, our results could improve patients selection for NAC, driving the decision-making in doubtful cases.

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Authors and Affiliations

  1. Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland

    Stefania Zamboni, Marco Moschini, Agostino Mattei & Philipp Baumeister

  2. Unit of Urology, Division of Oncology, IRCCS Ospedale San Raffaele, URI Milan, Milan, Italy

    Marco Moschini, Andrea Gallina, Renzo Colombo, Francesco Montorsi, Alberto Briganti & Andrea Salonia

  3. Urology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy

    Stefania Zamboni, Alessandro Antonelli, Claudio Simeone, Sandra Belotti & Luca Cristinelli

Authors
  1. Stefania Zamboni
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Contributions

SZ contributed to manuscript writing, statistical analyses and data collection. MM contributed to project development, data collection and drafting of the manuscript. AG contributed to critical revision of the manuscript. RC contributed to critical revision of the manuscript. FM contributed to critical revision of the manuscript. AB contributed to critical revision of the manuscript. AS contributed to critical revision of the manuscript. AA contributed to critical revision of the manuscript. CS contributed to critical revision of the manuscript. SB contributed to drafting of the manuscript. LC contributed to drafting of the manuscript. AM contributed to critical revision of the manuscript. PB contributed to project development, supervision and critical revision of the manuscript.

Corresponding author

Correspondence to Stefania Zamboni.

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The authors declare that they have no conflict of interest.

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All persons gave their informed consent to use their data for this retrospective study.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Zamboni, S., Moschini, M., Gallina, A. et al. The impact of completeness of last transurethral resection of bladder tumors on the outcomes of radical cystectomy. World J Urol 37, 2707–2714 (2019). https://doi.org/10.1007/s00345-019-02734-6

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