Impact of surgical experience on recurrence and progression after transurethral resection of bladder tumour in non-muscle-invasive bladder cancer. (June 2014)

• Record Type: Journal Article
• Authors: Jancke, Georg; Rosell, Johan; Jahnson, Staffan
• Is Part Of: Scandinavian journal of urology. Volume 48:Number 3(2014)
• Page Start: 276
• Page End: 283
• Publication Date: 2014-06
• Subjects: Urology -- Periodicals; 616.6
• DOI: 10.3109/21681805.2013.864327
• Languages: English
• ISSNs: 2168-1805

Abstract

<abstract> <title>Abstract</title> <p> <italic>Objective.</italic> This study aimed to evaluate the impact of experience in transurethral resection of bladder tumour (TURBT) on recurrence and progression in primary Ta/T1 urinary bladder cancer. <italic>Material and methods.</italic> Clinical and pathological characteristics of patients with primary Ta/T1 urinary bladder cancer were recorded prospectively from 1992 to 2007 inclusive. Data on surgeons' experience were categorized as follows: experience by training status (residents or specialists); number of TURBTs performed by each surgeon during the registration period, with cut-off levels at more than 100, more than 150, more than 200, greater than the median and above the third quartile of surgical volume; and lifetime high-volume surgeons (>100 TURBTs). Hazard ratios (HRs) were estimated using Cox regression with 95% confidence intervals (CIs) in multivariate analyses. <italic>Results.</italic> The analysis included 768 evaluable patients with a median follow-up of 60 months. Recurrence was observed in 478 patients (62%) and progression in 71 (9%). Surgery was performed by residents in 100 cases and specialists in 668, with recurrence in 75 (75%) and 403 (60%) patients, and progression in nine (9%) and 62 (9%), respectively. Surgery performed by specialists was significantly associated with a lower recurrence rate (HR = 0.68, 95% CI 0.53–0.87) but not progression (HR = 0.76, 95% CI 0.37–1.56). Surgical volume had no significant impact on recurrence or progression in any of the analyses at the chosen cut-offs. <italic>Conclusions.</italic> Surgical experience (specialist/resident) was predictive for recurrence after TURBT for Ta/T1 bladder cancer. Training programmes, checklists and specialist-assisted surgery may shorten the learning curve and improve results.</p> </abstract>