Do we need repeat transurethral resection after en bloc resection for pathological T1 bladder cancer?

Area of Science:

• Urology
• Oncology
• Pathology

Background:

• Pathological T1 (pT1) bladder cancer requires careful management after initial resection.
• En bloc resection of bladder tumour (ERBT) is a surgical approach for bladder cancer.
• The role of repeat transurethral resection (reTUR) and margin status after ERBT for pT1 disease is debated.

Purpose of the Study:

• To evaluate the clinical significance of reTUR after ERBT for pT1 bladder cancer.
• To assess the impact of surgical margin status on outcomes after ERBT.
• To determine the predictive value of surgical margins for residual tumor detection on reTUR.

Main Methods:

• Retrospective analysis of 106 patients with pT1 high-grade bladder cancer undergoing ERBT.
• Comparison of recurrence-free survival (RFS) and progression-free survival (PFS) between patients with and without reTUR.
• Analysis of surgical margin status (horizontal and vertical) and its association with residual tumor and outcomes.

Main Results:

• reTUR did not significantly improve 2-year RFS (55.1% vs 59.9%) or 3-year PFS (80.6% vs 82.6%).
• No patients were upstaged to pT2 following reTUR.
• Positive vertical margins were an independent predictor of worse PFS; residual tumors (pTa/is or pT1) were detected in reTUR specimens with positive margins.

Conclusions:

• reTUR following ERBT for pT1 bladder cancer does not appear to enhance recurrence or progression outcomes.
• Surgical margin status is a significant factor influencing prognosis and reTUR findings.
• Omission of reTUR may be considered for ERBT in pT1 bladder cancer patients with negative margins; reTUR remains standard for positive margins.