First and second transurethral resections in intermediate-high risk bladder cancer: impact of the surgeon's volume on the recurrence and progression of primary bladder cancer.

BACKGROUND

We evaluated the impact of surgeon's volume on recurrence and progression in patients with newly diagnosed transitional cell carcinoma of the bladder after first transurethral resection (TUR) and second-TUR.

METHODS

Between March 2005 and December 2012, 209 patients with intermediate-high risk primary bladder cancer who received second TUR within 2 to 6 weeks following the initial resection were prospectively included in a database and retrospectively analyzed. Surgeons were stratified into high-volume (>100 TUR) and low-volume (<100 TUR). Tumor recurrence and progression were analyzed respect to first and second-TUR and surgeon-volume.

RESULTS

Of the 209 patients who underwent second-TUR, 57 (27.2%) had macroscopic tumors before resection, which correlated to tumors multiplicity. Stage and surgeon category were independent predictors of tumor recurrence, with a 5-year recurrence-free survival rate of 52.7% and 23.1% for high and low-volume surgeon, respectively (P<0.001). Stage and surgeon category at first and second-TUR were independent predictor of tumor progression, with a 5-year progression-free survival rate of 83.8% and 48.0% for high and low-volume surgeon, respectively (P<0.001).

CONCLUSIONS

As for other major urological procedures, patients undergoing TUR performed by high volume surgeon may have better outcomes than patients operated by low-volume providers.