Early Re-Resection for T1 Transitional Cell Carcinoma of the Bladder—A Study of Current Practice in the South West of England

Abstract

Objective: To evaluate resection and re-resection practice in the South West region of England in patients with newly diagnosed T1 bladder cancer. Patients and methods: All patients diagnosed with T1 disease between 2005 and 2008 were identified. Patients with incomplete primary resections were excluded. Results: Of 344 patients identified, the primary resection specimen did not contain deep muscle in 110 (32%). In total, 76 patients (22%) underwent a planned re-resection within 8 weeks of their primary resection. In 225 patients, a routine check cystoscopy was performed at an interval of 3 months or greater. The remainder had no further cystoscopy. Residual disease was present in 38 (50%) patients undergoing early re-resection and 89 (40%) patients in the routine check cystoscopy group. Upstaging of tumours from T1 to T2 was demonstrated in 7% and 5% of patients within these respective groups. Grade of operating surgeon was not a predictor of adequacy of resection or tumour persistence/recurrence. Conclusions: Primary transurethral resection remains an area for improvement in contemporary practice. Early re-resection should be performed in patients with newly diagnosed T1 bladder cancer unless precluded by co-morbidity to ensure complete resection, accurate staging and facilitate risk stratification. Selective approaches to re-resection risk delayed treatment of significant residual disease.