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Background: Transurethral resection of bladder tumour (TURBT) is the primary treatment modality for Non-muscle invasive bladder cancer (NMIBC). Restaging transurethral resection of bladder tumour (RETURBT) is indicated to reduce risk of residual disease and correct staging errors after primary TURBT. The aim of the study is to evaluate the risk of...
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... instillation of Mitomycin C, per urethral catheter was kept clamped for 1 hour. Tumors were staged according to the 2017 TNM classification (Table 1) and graded according to the 2004 WHO classification ( Table 2). Presence of carcinoma in situ (CIS), Lymphovascular invasion and detrusor muscle was noted during histopathological review. ...Similar publications
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Citations
... There are only few studies from India related to the role of restage. Studies done in the Indian subcontinent on restage TURBT showed rate of recurrence of 28 to 60% and upstaging from 4 to 23% [15][16][17]. Various studies from the foreign countries noted recurrence rate from 16 to 78% and upstaging of 1 to 28% [5,8,18]. Current study depicts rate of recurrence as 16.7% which is lower compared to other Indian studies. ...
The increasing incidence of urinary bladder carcinoma is alarming. Approximately seventy percent of these patients are non-muscle invasive bladder cancer (NMIBC). Restage transurethral resection of bladder tumor (TURBT) is the current recommendation for any T1 and or high-grade non muscle invasive bladder cancers (NMIBC) to accurately stage the malignancy. The question whether a second surgery is always required as a restage procedure is still unanswered. The patient's concern about completeness, morbidity, and financial considerations of a major surgery cannot be overlooked. Moreover, it also puts a strain on the already overburdened healthcare system. To answer this question, whether it is oncologically sound to omit a second resection, the current study evaluated the outcomes of patients undergoing restage TURBT, and analyzed the preoperative factors predicting a change in the staging of this malignancy. The study design was a prospective observational including NMIBC patients from September 2018 to February 2020. A total of 72 patients underwent restage TURBT. Their demographic data, imaging and cystoscopic findings, and histopathological data were recorded. The objective was to study the clinico-pathological correlations and factors predicting recurrence and upstaging of tumor in NMIBC patients undergoing restage TURBT. A total of 101 patients were found eligible for restage TURBT. Eventually, 72 underwent restage TURBT. Twelve (16.7%) patient had recurrence at restage while 3(4.16%) were upstaged to T2. Presence of lower urinary tract symptoms (LUTS) was independently associated with the risk of recurrence of same stage compared to no recurrence (p-0.025, OR-8.793, 95% CI-1.316-98.773). Chemical exposure (p-0.042) was also significantly associated with the same. Presence of lymphadenopathy on CT was independently associated with the risk of upstaging compared to no recurrence (p-0.032, OR-18.25, 95% CI-1.292-257.85). The study concluded that in the presence of a well-performed and adequate initial TURBT, restage TURBT could be skipped for further management. However, in small subgroup of patients with lymphadenopathy on preoperative imaging having a higher risk of tumor recurrence and upstaging, and patients with a history of chemical exposure and previous lower urinary tract symptoms having a high risk of recurrence alone, restage TURBT should still be performed to accurately stage the disease. Further studies with large patient cohort are needed to confirm and reinforce the facts proposed.
Supplementary information:
The online version contains supplementary material available at 10.1007/s13193-022-01516-8.
Epidemiology: Bladder cancer (BC) is the tenth most prevalent malignancy and ranks thirteenth for cancer-related deaths [1]. Urothelial carcinoma (UC) accounts for approximately 90% of BC cases. Approximately 75% of the newly diagnosed BC cases were nonmuscle invasive, while 25% were muscle invasive [2]. The incidence and mortality rates of BC were highest in Eastern Asia (132,316 cases and 54,206 deaths), followed by Northern America (89,997 cases and 21,045 deaths), and Western Europe (68,143 cases and 20,866 deaths) [3]. Further, the global incidence and mortality rates were significantly higher in males (440,864 cases, cumulative risk 1.05; 158,785 deaths, cumulative risk 0.30) than in females (132,414 cases, cumulative risk 0.26; 53,751 deaths, cumulative risk 0.08). The age-standardized incidence rate of BC was highest in Southern Europe with 15.3 cases per 100,000, followed by Western Europe and Northern America (13.0 and 10.9 per 100,000 respectively) [3]. The least incidence rate was observed in Middle Africa followed by South-Central Asia and Western Africa [3]. The 5-year survival rate depends on the stage of malignancy, with the highest rate of survival in the in-situ stage (95.8%), compared to the localized (69.5%), regional (36.3%), and metastatic cases (4.6%) [1].
