MP13-02 IS RE-RESECTION NECESSARY? RE-RESECTION OF NON-MUSCLE INVASIVE BLADDER CANCER AT A TERTIARY CARE CENTER

You have accessJournal of UrologyBladder Cancer: Non-Invasive I1 Apr 2016MP13-02 IS RE-RESECTION NECESSARY? RE-RESECTION OF NON-MUSCLE INVASIVE BLADDER CANCER AT A TERTIARY CARE CENTER Rano Matta, Ashraf Al Matar, Bimal Bhindi, Alexander Zlotta, Neil Fleshner, Michael Jewett, Robert Hamilton, Antonio Finelli, and Girish Kulkarni Rano MattaRano Matta More articles by this author , Ashraf Al MatarAshraf Al Matar More articles by this author , Bimal BhindiBimal Bhindi More articles by this author , Alexander ZlottaAlexander Zlotta More articles by this author , Neil FleshnerNeil Fleshner More articles by this author , Michael JewettMichael Jewett More articles by this author , Robert HamiltonRobert Hamilton More articles by this author , Antonio FinelliAntonio Finelli More articles by this author , and Girish KulkarniGirish Kulkarni More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2483AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Re-staging transurethral resection (re-TUR) of T1 bladder tumors provides more accurate staging, and is associated with better local control. Re-TUR has been included in guidelines for management of non-muscle invasive bladder cancer since 2007. However, in practice, re-TUR has been questioned in the setting of perceived complete resection at initial TUR, amongst other patient and surgeon specific factors. We aimed to understand the practice patterns of re-TUR of T1 urothelial carcinoma at our center and its predictors. We also determined outcomes associated with re-TUR at a Canadian tertiary care center. METHODS We retrospectively identified 358 consecutive patients with pT1 high grade urothelial carcinoma of the bladder who were treated at the University Health Network, Toronto, from 2000 to 2012. We excluded those who had metastatic disease on diagnosis, those treated primarily with cystectomy or chemotherapy/radiation after TURBT. Those treated with early cystectomy or chemotherapy/radiation after re-TUR were not included in the final cohort. Patients who did not undergo immediate/early cystectomy were offered adjuvant BCG therapy. The remaining 270 patients were included in the final analysis. We compared re-TUR rates in the pre- (2000-2008) and post-guideline (2009-2012) era. End points were time to recurrence, time to progression (defined as stage T2 or higher), and mortality. Univariate and multivariate analyses were used to determine any significant effect of patient specific factors (age, gender) and disease specific factors (associated CIS, muscle sampled, immediate chemotherapy) on proceeding for re-TUR. We also performed Cox-proportional hazard models to determine risk factors for recurrence, progression, and survival. RESULTS The median age of the cohort was 68.9 years (18-97) with a mean follow up 3.3 years (0.08-13.3 years). Re-TUR was performed in 109 patients (40%). The average re-TUR rate increased after 2008 from 31.6% to 51.3% (p=0.038). There was residual tumor in 70% of re-TUR cases. Upstaging to T2 disease on re-TUR was seen in 16.5% of patients. There was residual pT1 in 29.4% of cases. Residual T1 disease at re-TUR was a significant risk factor for progression (HR 38.1; CI 5.9-246.6). Re-TUR was not a significant risk factor for recurrence, progression or mortality. CONCLUSIONS Overall, re-TUR is an important therapy, decision-making and prognostication tool in NMIBC. However, in terms of the effectiveness of re-TUR on recurrence and progression, further prospective studies will provide more definitive information. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e134 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Rano Matta More articles by this author Ashraf Al Matar More articles by this author Bimal Bhindi More articles by this author Alexander Zlotta More articles by this author Neil Fleshner More articles by this author Michael Jewett More articles by this author Robert Hamilton More articles by this author Antonio Finelli More articles by this author Girish Kulkarni More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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