The need for re-staging transurethral resection of bladder tumour (ReTURBT) in Ta high grade and T1 tumours: Questioning the norms—Inferences from a national institute.

Abstract

79 Background: The incidence of urinary bladder carcinoma is increasing at an alarming rate. Non-Muscle Invasive Bladder Cancer (NMIBC) accounts for seventy percent of these patients. Current guidelines recommend a Restage Transurethral Resection of Bladder Tumour (ReTURBT) for Ta high-grade and all T1 non-muscle invasive tumours, to increase the accuracy of staging. The question of whether a second surgery is always necessary remains unanswered. Here, the patient's concern about the completeness of the procedure, perioperative morbidity, and the financial burden involved in a major surgery cannot be ignored. Moreover, it also puts a strain on the already overburdened healthcare systems in developing countries like India. Trying to answer this question of whether it is oncologically sound to omit a second resection, our study evaluated the outcomes of patients undergoing restage TURBT with regards to the rate of upstaging, upgrading and residual tumours in these patients. Methods: The study was a retrospective analysis of a prospectively maintained database including NMIBC patients from September 2019 to February 2023. A total of 112 patients underwent restage TURBT. Their demographic details, imaging, cystoscopy findings, and histopathological data were recorded. The primary objective was to analyse the rate of upstaging, while the secondary objectives were to look at the residual tumour and upgrading rates in these patients. Results: Out of 112 patients (T1- 71 & Ta high grade- 41), 24 patients (21.42%) had residual tumours at restage (T1- 20 & Ta high grade- 4) while 21 (18.75%) patients (T1- 19 & Ta high grade- 02) were upstaged to T1 or T2. Grade progression was seen in 15.41 % T1 patients, while none of the Ta high grade patients had a change in grade. Deep muscle in the initial resection was present in 87.5 % of the specimens. Conclusions: Our retrospective analysis points towards skipping a restage TURBT in select Ta patients in whom a well-performed and adequate initial TURBT was done. Further prospective studies with large patient cohorts are needed to confirm and reinforce these proposed facts.