Bos Derek, Allard Christopher B, Dason Shawn, Ruzhynsky Vladimir, Kapoor Anil, Shayegan Bobby
a McMaster University , Hamilton , ON , Canada ;
b Massachusetts General Hospital , Boston , MA , USA ;
Scand J Urol. 2016 Jun;50(3):234-8. doi: 10.3109/21681805.2016.1163616. Epub 2016 Apr 4.
Transurethral resection of bladder tumor (TURBT) pathology specimens which lack muscle are associated with clinical upstaging and may necessitate repeat resections, potentially delaying curative treatment. This study evaluated whether resident involvement in TURBT is associated with suboptimal perioperative outcomes.
All TURBTs performed at a Canadian healthcare institution from November 2011 to June 2014 were reviewed. Multivariable logistic regression models assessed associations between intraoperative resident involvement and TURBT muscle presence. Among high-risk patients (high grade, ≥ T1 or carcinoma in situ) who underwent cystectomy, time from TURBT to cystectomy was compared between resident and attending urologists with the log-rank test.
In total, 463 TURBTs were identified. In multivariable analyses, residents were less likely to obtain muscle in specimens for all TURBTs [adjusted odds ratio (aOR) 0.59, p = 0.03] and the subset of 275 high-risk TURBTs (aOR 0.41, p = 0.006). Among patients who underwent cystectomy, time to cystectomy was delayed by a median of 23 days when residents were involved in the initial high-risk TURBT compared with attending urologists only (p = 0.024).
In this single academic center series, intraoperative resident involvement was associated with a decreased rate of muscle presence in TURBT specimens and a prolonged time to cystectomy.
膀胱肿瘤经尿道切除术（TURBT）病理标本中无肌肉组织与临床分期升级相关，可能需要再次切除，这可能会延迟根治性治疗。本研究评估住院医师参与TURBT是否与围手术期效果欠佳有关。
回顾了2011年11月至2014年6月在一家加拿大医疗机构进行的所有TURBT。多变量逻辑回归模型评估术中住院医师参与情况与TURBT标本中肌肉组织存在情况之间的关联。在接受膀胱切除术的高危患者（高级别、≥T1或原位癌）中，使用对数秩检验比较住院医师和主治泌尿科医生从TURBT到膀胱切除术的时间。
共识别出463例TURBT。在多变量分析中，住院医师在所有TURBT标本中获取肌肉组织的可能性较小[调整后的优势比（aOR）为0.59，p = 0.03]，在275例高危TURBT子集中也是如此（aOR为0.41，p = 0.006）。在接受膀胱切除术的患者中，与仅由主治泌尿科医生进行初始高危TURBT相比，住院医师参与时膀胱切除术的时间中位数延迟了23天（p = 0.024）。
在这个单一学术中心系列研究中，术中住院医师参与与TURBT标本中肌肉组织出现率降低以及膀胱切除术时间延长有关。
