Shariat - Figure 20
Step 2: Second TURBT
FIG. 20: A repeat TUR between 2 and 6 weeks after the primary resection is essential in the management of T1 bladder cancer. The reasons for that are that the re-TUR minimizes the risk of misstaging and lowers the recurrence rate at the primary resection site, as discussed previously, and improves the outcomes of adjuvant conservative/intravesical therapies.
Herr and colleagues[24] showed that the second TURBT improves initial response to BCG, and Divrik’s group[25] reported that it improves initial response to mitomycin in an adjuvant setting.
Persistent T1 on the re-resection carries a very high risk of disease progression, originally estimated to be around 75% at 5 years, despite optimal treatment with BCG. Newer studies show that this rate is lower, probably around 30–40% at 5 years.[26] Nevertheless this patient group with a T1 on re-resection has a high propensity of disease progression and could be considered for immediate or early radical cystectomy.
So there is no doubt in any of the guidelines that a second TURBT for a T1 high-grade tumor is a must, even for experienced urologists.
References
Herr HW. Restaging transurethral resection of high risk superficial bladder cancer improves the initial response to bacillus Calmette-Guerin therapy. J Urol. 2005;174:2134−7 http://dx.doi.org/10.1097/01.ju.0000181799.81119.fc
Divrik RT, Yildirim U, Zorlu F, Ozen H. The effect of repeat transurethral resection on recurrence and progression rates in patients with T1 tumors of the bladder who received intravesical mitomycin: a prospective, randomized clinical trial. J Urol. 2006;175:1641−4 http://dx.doi.org/10.1016/S0022-5347(05)01002-5
Raj GV, Herr H, Serio AM, et al. Treatment paradigm shift may improve survival of patients with high risk superficial bladder cancer. J Urol. 2007;177:1283−6 https://doi.org/10.1016/j.juro.2006.11.090
