MP59-12: DEpth of Endoscopic Perforation (DEEP scale): a new classification to predict early post-operative outcomes in the endoscopic treatment of bladder cancer.

Alberto Piana*, Andrea Gallioli, Pietro Diana, Angelo Territo, Matteo Fontana, Rodriguez Faba Óscar, Josep Maria Gaya, Ruben Parada, Asier Mercadé, Jorge Robalino, Joan Palou, Alberto Breda, Barcelona, Spain

Introduction: Transurethral resection of bladder tumor (TURBT) is the standard treatment for non-muscle invasive bladder cancer (NMIBC). An adequate specimen obtained from the resection should include a muscle layer to provide an optimal diagnosis. On the other hand, a deep resection of the lesion may result in a bladder wall perforation. The aim of our study was to design a classification of the depth of perforation of bladder wall and to assess its role in predicting post-operative variables.

Methods: This is a sub-analysis of a prospective randomized trial enrolling patients diagnosed with NMIBC and undergoing en-bloc vs conventional TURBT from 03/2018 to 06/2021. The DEpth of Endoscopic Perforation (DEEP scale) scale was designed as grade “0” when the muscular layer was visible with no perivesical fat; “1” in case of visible muscle fibers with spotted perivesical fat; “2” exposition of perivesical fat; “3” complete perforation. A descriptive assessment of perioperative complications stratified per grade of perforation was performed. Univariate logistic and linear analyses were performed to analyze the correlation between the perforation grade and demographic/perioperative variables. Cox regression was performed to evaluate recurrence-free survival, overall survival and cancer-specific survival.

Results: 248 patients were enrolled in this study. Median age (IQR) was 72 years (64-80); 200 (80.64%) patients were males and 48 (19.35%) females. Statistical analyses are reported in Table 1. Age and gender did not appear to be correlated with surgical outcome. Moreover, the depth of the perforation was not correlated with the quality of the specimens (presence of detrusor, pTx). Notably, the DEEP scale was significantly associated to a higher rate of Clavien ³ 3 complications (B (CI 95%): 2.1 (1.05; 4.2; p=0.035), a lower rate of post-operative chemotherapy intravesical instillation (B: 5.579 (2.359;13.191; p=0.00), a longer post-operative bladder irrigation time (B: 0.316 (0.173;0.459; p=0.00) and hospital stay (B: 0.385 (0.174;0.597; p=0.00). Catheter maintenance seemed to be influenced by the DEEP grade despite it did not reach statistical significance (B: 0.350 (-0.002;0.703). No correlation was found between DEEP grade and recurrence-free, overall survival, and cancer-specific survival (all p > 0.05).

Conclusions: We designed a new classification of the bladder wall perforation depth, which predicts a worse postoperative surgical outcome with no impact on pathological and oncological outcomes.

Source of Funding: None