First and second transurethral resections in intermediate-high risk bladder cancer: impact of the surgeon's volume on the recurrence and progression of primary bladder cancer
Del Zingaro, M.; Bruno, R.; Nunzi, E.; Porena, M.; Mearini, L.
Minerva Urologica e Nefrologica 68(2): 194-203
2016
ISSN/ISBN: 0393-2249 PMID: 25916218 Document Number: 687834
We evaluated the impact of surgeon's volume on recurrence and progression in patients with newly diagnosed transitional cell carcinoma of the bladder after first transurethral resection (TUR) and second-TUR. Between March 2005 and December 2012, 209 patients with intermediate-high risk primary bladder cancer who received second TUR within 2 to 6 weeks following the initial resection were prospectively included in a database and retrospectively analyzed. Surgeons were stratified into high-volume (>100 TUR) and low-volume (<100 TUR). Tumor recurrence and progression were analyzed respect to first and second-TUR and surgeon-volume. Of the 209 patients who underwent second-TUR, 57 (27.2%) had macroscopic tumors before resection, which correlated to tumors multiplicity. Stage and surgeon category were independent predictors of tumor recurrence, with a 5-year recurrence-free survival rate of 52.7% and 23.1% for high and low-volume surgeon, respectively (P<0.001). Stage and surgeon category at first and second-TUR were independent predictor of tumor progression, with a 5-year progression-free survival rate of 83.8% and 48.0% for high and low-volume surgeon, respectively (P<0.001). As for other major urological procedures, patients undergoing TUR performed by high volume surgeon may have better outcomes than patients operated by low-volume providers.