PD26-11: Does surgeon's opinion during the primary transurethral resection of bladder tumor surrogate the need for repeated resection? A preliminary results.

Yasser Osman*, Mansoura, Egypt, M Elbaset, Cairo, Egypt, Ahmed Harraz, Mohamed Ramez, Islam M Hawash, Abdullah A Sobh, Ahmed Elghareeb, Ahmed Elhussein Abolazm, R.F. Elbaz, Ahmed Elkarta, Ahmed Lashin, Rasha T Abouelkheir, Ahmed Mosbah, Mansoura, Egypt

Introduction: Transurethral resection of the bladder (TURBT) is the standard procedure for bladder cancer diagnosis and treatment for patients with non-muscle invasive bladder cancer (NMIBC). All the guidelines recommend the second look TURBT in subset of T1 bladder tumor and absence of muscle tissue in the specimen. Second look TURBT represents an expensive procedure with negative impact on the health care costs. In this preliminary study, we tried to assess the intraoperative assessment of the tumor-free status during primary TURBT in judging the necessity of the second look TURBT.

Methods: In a prospective observational study between May and October 2021 included all patients with NMIBC who underwent TURBT. Second look TURBT was indicated in case of muscle absence in the resected tissue, T1 tumor or incomplete resection. Patients with incomplete resection were excluded from the study. Cystoscopic description of bladder tumor included; size, number, site and gross morphology. After the procedure, the surgeons were asked for their perspective about the need for second look re-TURBT and the answers was either (yes, no). Tumors were classified histologically according to WHO/ISUP 2004 consensus classification of transitional cell tumors of the bladder.

Results: Sixty three patients were included in the analysis. Mean age was 58.8±11.1 years. The majority presented with hematuria (90.5%). Twenty-seven (42.9%) had recurrent bladder tumor. Tumor size less than 3 cm were found in 70% of the cases whilst, 55% were single in number. Sixty patients (95.2%) were managed by conventional TURBT while others were managed by Holmium LASER enblock Resection of bladder tumor (HOLEBRT) or bipolar resection in view of obturator jerk during the resection. In 49 patients (77.8%), surgeon were satisfied about the completeness of the resection and the need of the second was not suggested. In the remaining patients, surgeon’s recommended second look TURBT. Low grade tumors were detected in 35 (55.6%) patients. Muscle detection in the resected tissue was found in 37 (58.7%) patients. In univariate and multivariate analysis, surgeon’s opinion (no need for second look TURBT), lower grade of the tumor and presence of muscle tissue resected in the first TURBT were predictors for negative results in the second look TURBT (P=0.01, <0.0001 and 0.023, respectively).

Conclusions: In this preliminary report, surgeon’s opinion can play a decisive role in second look TURBT necessity. Nevertheless, second look TURBT should be indicated despite the surgeon’s opinion in case of high tumor grade or absence of muscle tissue in the specimen.

Source of Funding: None