Adherence to Good Quality transurethral resection of the bladder (GQ-WLTURBT) markers in high volume centres: results from 4 North Italian institutions
The goals of the Transurethral resection of the bladder (TURB) are to remove all visible lesions and to make a correct diagnosis. An incomplete or "poor-quality" resection can result in an inaccurate staging or early recurrence. The aim of our study was to verify the adherence to the well established good-quality markers for TURB(GQ-WLTURBT) in daily practice in 4 high volume centres
Data from 410 consecutive patients who underwent TURB before August 2016 at 4 high-volume North Italian institutions (two academic and two non-academic) were retrospectively collected. Inclusion criteria were macroscopic bladder tumour present and any positive pathological report for bladder cancer. GQ-WLTURBT was defined as having the following features: presence of detrusor muscle (DM) in the specimen, and patient receiving early instillation mitomycin C within 24 hour of the resection, adequate re-TURB within 8 weeks. The following parameters were reported: type of resection (in fractions en bloc resection), early instillation after the procedure. We reported also histological report of TURB specimens with histological type of tumour, TNM clinical classification, 2004 WHO grading system, the status of DM. For each patients we reported any re-TURB.
En bloc resection was performed in 18/410 cases (4.3%). Tumour grade was reported in 99.2% of cases. Status of DM was reported in 334/410 cases (81.4%), DM was present in 266/410 patients (64.9%) and not present in 68/410(16.6%). Of these 68, Ta, T1 and CIS was found in 44, 17, and 7 patients, respectively. Nine patients with Ta and 16 with T1 were High Grade (HG). Out of these, only 11/25 (44%) underwent re-TURB and 36% (4/11) had residual tumour. Out of the non-reported DM group 18 patients were Ta-HG, 12 patients were T1. Out of these only 9/30 (30%) underwent re-TURB and 7/9 (77.7%) had residual tumour. According to the 2017 EAU guidelines, 185/410 patients should’ve received an early instillation, but only 44/180 patients (23.7%) received it. Twelve patients underwent early instillation but were HG at final pathology. Re-TURB was performed in 80/410 (19.5%) patients, was expected in 146 (35.6%) or 115 (28%) patients according to the 2016 or 2017 EAU guidelines, respectively. Re-TURB was performed in 39/77 (50.6%). 25/58 (43.1%) in the T1HG and TaHG groups respectively. In the subgroup of 27/58 (46.5%) TaHG patients who had no DM either reported or present, only 7/27 (25.9%) underwent re-Turbt. Of these,4 patients (57.1%) had residual tumour. 28/77 (36.3%) T1HG patients did not have DM reported or present, 13/28 (46.4% underwent a re-TURB and 7/13 (53.8%) had residual tumour.
Our findings showed that the adherence to international guideline remains low even in high volume centers. International educational programs should be improved worldwide in order to offer higher standardized procedures