PD25-10 RESIDENT INVOLVEMENT IN ENDOSCOPIC BLADDER CANCER SURGERY IS ASSOCIATED WITH INADEQUATE PATHOLOGY SPECIMENS AND PROLONGED TIME TO CYSTECTOMY

Abstract

You have accessJournal of UrologyBladder Cancer: Detection and Screening II1 Apr 2015PD25-10 RESIDENT INVOLVEMENT IN ENDOSCOPIC BLADDER CANCER SURGERY IS ASSOCIATED WITH INADEQUATE PATHOLOGY SPECIMENS AND PROLONGED TIME TO CYSTECTOMY Derek Bos, Christopher Allard, Shawn Dason, Vladimir Ruzhynsky, Anil Kapoor, and Bobby Shayegan Derek BosDerek Bos More articles by this author , Christopher AllardChristopher Allard More articles by this author , Shawn DasonShawn Dason More articles by this author , Vladimir RuzhynskyVladimir Ruzhynsky More articles by this author , Anil KapoorAnil Kapoor More articles by this author , and Bobby ShayeganBobby Shayegan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1659AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transurethral resection of bladder tumor (TURBT) specimens lacking detrusor muscle are associated with clinical upstaging and the need for additional procedures which may delay curative treatment. We evaluated whether resident involvement in TURBTs is associated with adequacy of pathology specimens and time to cystectomy at a single academic centre in Ontario, Canada. METHODS We identified all TURBTs performed at St. Joseph's Healthcare Hamilton from November 2011 to June 2014. Charts were reviewed to determine baseline characteristics, resident involvement, and pathologic findings including presence of detrusor muscle. Logistic regression was used to assess associations between resident involvement and adequacy of tumor specimens. Among patients who underwent cystectomy, we assessed the time to cystectomy from initial high risk TURBT (high grade, ≥T1, or CIS), excluding patients with subsequent low risk TURBTs, BCG, or neoadjuvant chemotherapy. Associations between resident involvement with pathologic outcomes and time to cystectomy were determined with Chi−square and log rank tests, respectively. RESULTS A total 664 TURBTs were performed on 471 patients during the study period. Patient and tumor characteristics were comparable for TURBTs performed by attendings and residents. Attendings were more likely to obtain muscle in specimens for all TURBTs (OR1.68 [95%CI 1.09, 2.59], p=0.018) and for the subset of 275 high risk TURBTs (OR1.99 [95%CI 1.11, 3.55], p=0.019). Senior residents (PGY3−5) had higher odds of muscle in all (OR1.91 [95%CI 1.12, 3.25], p=0.017) and high risk (OR2.9 [95%CI 1.43, 5.9], p=0.003) specimens compared with juniors. In multivariate analysis adjusting for covariates patient age, sex, and tumor size, resident involvement was associated with inadequate tumor specimens among all patients (p=0.032) and only high risk tumors (p=0.049). Resident involvement was associated with a non-significant increased need for repeat TURBT. The median time from initial high risk TURBT to cystectomy was 73.3 (IQR 51.8, 131.4) and 49.4 (IQR 31.4, 65.7) days for residents and attendings, respectively (p=0.024). CONCLUSIONS Resident involvement during TURBTs is associated with inconclusive pathology and delayed time to cystectomy. Future studies should assess educational tools to improve endoscopic surgical training techniques minimizing effects of resident learning on patient outcomes. Further studies are needed to clarify the impact of resident involvement on long-term patient outcomes. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e564 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Derek Bos More articles by this author Christopher Allard More articles by this author Shawn Dason More articles by this author Vladimir Ruzhynsky More articles by this author Anil Kapoor More articles by this author Bobby Shayegan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...