Correlation between surgeon’s experience and pathological and oncological outcomes after transurethral resection of the bladder: results from a multicentric retrospective study
A good-quality transurethral resection of the bladder (GQ-WLTURB) warrants the removal of all visible lesions, providing good quality detrusor muscle (DM) for analysis allowing an accurate staging. Evidence from the literature suggests that surgeon’s experience can influence the outcome of this procedure. The aim of our study was to investigate the correlation between the surgeon's experience and the pathological and oncological outcomes following the well-established good-quality markers for Turb
Data from 410 consecutive patients who underwent Turb before August 2016 at 4 high-volume North Italian institutions (two academical and two non) were retrospectively collected. Inclusion criteria were macroscopic bladder tumour present and any positive pathological report for bladder cancer. Surgeons were classified as junior (JS) (<100 Turb), intermediate (IS) (100<Turb<250) and expert (ES)(>250 Turb). For each procedure we reported the presence of DM in bladder specimen, any complication using the Clavien-Dindo classification, recurrence at three-months, any re-Turb, specifying if there was present. These outcomes were stratified according to surgeon experience.
Of all the procedures, 64/410 (15.6%), 108/410 (26.6%), and 238/410 (58%) were performed by the JS, IS, ES, respectively. Complications were reported in 6/64 (9.3%), 3/108 (2,7%) and 28/238 (11,7%) patients in the JS, IS and ES groups, respectively. (JS, p=0.91, OR 1.05; IS, p=0.015, OR 0,22; ES p=0.026, OR 2,41) Cystoscopy at the 3 month followup was performed in 279/410 patients and a recurrence was found in 9/48 (18,75%), 10/70 (14,28%), 34/161 (21,1%) of the JS, IS and ES groups, respectively (JS, p=0.96, OR 0,98; IS, p=0,24, OR 0,64; ES p=0.29, OR 1.39) Overall, 80/410 (19.5%) patients underwent re-Turb. Of this group, the first TUR was performed by JS, IS or ES in 13/80 (16.25%), 24/80(30%), 43/80(53.7%) patients, respectively. No statistical difference was found between the groups when considering tumour size and number of tumours (p=0.1 and p=0,3 respectively). Re-Turb showed a residual tumour in 2/13(15,3%), 7/24(29,1%) and 24/43(55%) patients (JS, p=0.018, OR 0.17; IS, p=0.35, OR 2.26; ES p=0.019, OR 6.94), in the JS, IS and ES groups, respectively. Status of DM was reported in 59/64 (92,1%), 102/108 (94,4%), 173/238 (72,6%) in the JS, IS and ES groups respectively. No DM was found in 9/59 (15,2%), 21/102 (20,5%) and 38/173 (21.9%) in the JS, IS and ES groups, respectively (p=0.54).
No difference was found among the groups when comparing the presence of DM in the specimen. Although no significance was found between early recurrence at the 3 month cystoscopy, residual tumour was more likely to be found in the ES group at re-turb. ES seem to have more surgical complications than JS while the IS seem to have overall less complications. These findings underline the importance of respecting the guidelines of a good quality turb regrdless of surgical experience