Second transurethral resection in T1G3 bladder tumors - Selectively avoidable?
Francis S Katumalla1, Antony Devasia, Ramani Kumar
1Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India.
Summary
A second transurethral resection (TUR) is recommended for most T1G3 bladder tumors to detect residual or invasive disease. However, solitary papillary lesions may not require a second TUR, suggesting a need for personalized treatment strategies.
Area of Science:
- Uro-oncology
- Surgical oncology
- Pathology
Background:
- T1G3 bladder tumors are high-risk and require careful management.
- The role of a second transurethral resection (TUR) in these patients is debated.
Purpose of the Study:
- To evaluate the necessity of a second TUR in patients with T1G3 bladder tumors.
- To identify patient subgroups that may benefit from or be spared a second TUR.
Main Methods:
- Retrospective review of 50 patients with pT1G3 bladder tumors who underwent a second TUR.
- Classification of primary lesions into solitary papillary, multiple papillary, and sessile types.
- Histopathological examination of resected tissue, including muscularis propria.
Main Results:
- Thirty-six percent of patients had residual disease, and 4% were upstaged after the second TUR.
- Residual disease was found in 50% of multiple papillary and 83.3% of sessile lesions.
- Only 5% of solitary papillary lesions showed residual disease, suggesting this group may not need a second TUR.
Conclusions:
- T1G3 bladder tumors are heterogeneous, and a second TUR is valuable for detecting residual/invasive disease.
- The recommendation for a second TUR should consider tumor morphology.
- Solitary papillary T1G3 lesions might be an exception where a second TUR's necessity is questionable.
