The Effect of Surgeon Experience on the Recurrence of Non-Muscle Invasive Bladder Cancer (NMIBC), Following Transurethral Resection of the Bladder Tumor (TURBT): A double Blinded Prospective Randomized Study.

Abstract

Background: Transurethral resection of the bladder tumor (TURBT) followed by intravesical instillation therapy is the standard treatment for non-muscle invasive bladder cancer (NMIBC). One of the factors that may affect the risk of recurrence after TURBT is the quality of surgery that may vary between individual surgeons. While there has been a large number of studies demonstrating the ability to reduce the risk of recurrence of NMIBC with different types of the intravesical therapy, less attention was paid to the quality of TURBT in improving long-term treatment results. The aim of the study is to evaluate the effect of the quality of TURBT on the recurrence rate of NMIBC based on surgeon experience.

Methods: The study is a double blinded prospective randomized study conducted on 50 patients with NMIBC. who underwent 126 procedures (50 primary cystoscopies ,26 restaging cystoscopies and 50 check cystoscopies at three months). All Treatment-naive patients with NMIBC candidate for TURBT were included, with exclusion of patients with previous history of TURBT, previous open bladder surgery, patients with urethral stricture, patients with muscle invasive bladder cancer. And patients who lost follow up. Patients were randomized by closed envelope into two groups; Group A included 25 patients who underwent TURBT by a senior surgeon (more than 5 years' experience), and Group B included 25 patients underwent TURBT by a qualified junior surgeon (less than 5 years' experience).  Restaging cystoscopy at 2-6 weeks (if indicated) and follow up cystoscopy at three months were performed by another senior surgeon (who was blinded to the name of the first surgeon).

Results: No statistically significant difference was found between both groups regarding the incidence of complications (urethral injury, bladder perforation, ureteric injury, obturator reflex), Group B showed a statistically significant longer operative time, postoperative irrigation time, more hemoglobin loss, longer hospital stay, and higher 3 months' recurrence rates. Moreover, senior surgeons' specimens were more likely to include detrusor muscles.

Conclusion: surgeon's experience has significant impact on the quality of TURBT and risk of recurrence of NMIBC. With less operative time, less hemoglobin drop, and less hospital stay.