Role of restage transurethral resection of bladder tumor in high-risk non-muscle invasive bladder cancer

Abstract

Background: Patients with non-muscle invasive bladder cancer (NMIBC) often have transurethral resection of the bladder tumor (TURBT). Inadequate TURBT, floating tumor cell implantation theory, and non-visualized microtumors are major factors for the recurrence of bladder cancer. According to guideline recommendations, after primary TURBT, there is a role of restage TURBT within 2–6 weeks in high-risk patients. The present study’s goal was to assess the role of restage TURBT in high-risk NMIBC. Aims and Objectives: The aim of the study was to identify the group of patients with high-risk NMIBC who may skip the commonly performed restage TURBT operation. Materials and Methods: In this prospective and observational study, biopsy-proven NMIBC patients with gross total painless hematuria secondary to urinary bladder mass from October 2017 to June 2019 were enrolled. Patients with high-risk disease will undergo restage TURBT after 2–6 weeks of primary TURBT. Residual/recurrent disease and tumor upstaging were recorded. To investigate the risk variables for tumor upstaging after restaging TURBT and residual/recurrent disease, logistic regression analysis was utilized. Results: A total of 250 patients (deep muscle involvement, n = 237 and no muscle involvement, n = 13) with histopathologic ally-confirmed high-risk disease following re-TURBT were included in the final analysis. During re-TURBT, 18% of patients had residual or recurrent tumors. The presence of upper tract changes, presence of perivesical fat stranding and tumor size >3 cm, high-grade histopathology, and positive urine for malignant cytology had a higher risk of residual or recurrent disease. Histopathological specimens showing the absence of muscle in the primary TURBT specimen, the presence of recurrent/residual growth in restage TURBT specimen, and bladder tumor antigen increased the risk of upstaging. Conclusion: Despite the low recurrence rate of tumors in restage TURBT, restage TURBT within 2–6 weeks of primary TURBT is an essential step for the accurate diagnosis among NMIBC patients. This further aids in deciding the subsequent treatment step in patients having upstaging and recurrent/residual tumors.