Clinical value of transurethral second resection of bladder tumor: systematic review
Jakub Dobruch1, Andrzej Borówka2, Harry W Herr3
1Department of Urology, Center of Postgraduate Medical Education, Warsaw, Poland; Young Academic Urologists of European Association of Urology Bladder Cancer Group.
Objective:
To systematically review prospective trials aimed at the role of restaging transurethral resection (reTUR) to define the group of patients with bladder cancer who would benefit.
Materials And Methods:
A systematic review of the literature in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines was conducted.
Results:
Of 120 trials, 7 met the inclusion criteria. Most studied populations were high-risk non-muscle-invasive bladder cancer patients. Low-risk cancers as well as muscle-invasive disease were analyzed in only 1 trial. Consistently through the publications, reTUR improved staging with the rates of muscle-invasive disease mounting to 17.6% when primary resection was deemed to be complete. Although all trials corroborated staging role of reTUR, only 4 provided recurrence and progression outcomes, the first being significantly lower in the group of second early resection. In 2 studies with the longest follow-up and the greatest number of patients with high-risk non-muscle-invasive bladder cancer, progression rates were found to be improved. In one trial, reTUR was associated with better response to bacille Calmette-Guérin.
Conclusion:
The data convincingly suggest that early second resection improves staging and reduces the recurrence as well as progression rates of high-risk bladder tumors. reTUR brings benefit to those subjected to bacille Calmette-Guérin. However, additional surgery would not modify treatment plan in those with low-risk disease.
