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JU INSIGHT Impact of Maximal Transurethral Resection on Pathological Outcomes at Cystectomy

By: Peter S. Kirk, MD, University of Washington, Seattle; Yair Lotan, MD, University of Texas Southwestern, Dallas; Homayoun Zargar, MD, PhD, Western Health, Melbourne, Australia; Adrian S. Fairey, MD, USC/Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, University of Alberta, Edmonton, Canada; Colin P. Dinney, MD, MD Anderson Cancer Center, Houston, Texas; Maria C. Mir, MD, Fundacio Instituto Valenciano de Oncologia, Valencia, Spain; Laura-Maria Krabbe, MD, University of Münster, Germany; Michael S. Cookson, MD, University of Oklahoma College of Medicine, Oklahoma City; Niels-Erik Jacobson, MD, University of Alberta, Edmonton, Canada; Jeffrey S. Montgomery, MD, University of Michigan Health System, Ann Arbor; Nikhil Vasdev, MD, Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage, United Kingdom, Freeman Hospital, Newcastle Upon Tyne, United Kingdom; Evan Y. Yu, MD, University of Washington, Seattle, Fred Hutchinson Cancer Center, Seattle, Washington; Evanguelos Xylinas, MD, Weill Cornell Medical College, Presbyterian Hospital, New York, New York; Wassim Kassouf, MD, McGill University, Health Center, Montreal, Quebec, Canada; Marc A. Dall’Era, MD, University of California at Davis, Davis Medical Center, Sacramento; Srikala S. Sridhar, MD, Princess Margaret Hospital, Toronto, Ontario, Canada; Jonathan S. McGrath, MD, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, United Kingdom; Jonathan Aning, Freeman Hospital, Newcastle Upon Tyne, United Kingdom, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, United Kingdom; Shahrokh F. Shariat, MD, University of Texas Southwestern, Dallas, Weill Cornell Medical College, Presbyterian Hospital, New York, New York, Medical University of Vienna, Vienna General Hospital, Austria; Andrew C. Thorpe, MCh, FRCS, MB BCh, Freeman Hospital, Newcastle Upon Tyne, United Kingdom; Todd M. Morgan, MD, University of Michigan Health System, Ann Arbor; Jeff M. Holzbeierlein, MD, University of Kansas Medical Center, Kansas City; Trinity J. Bivalacqua, MD, PhD, University of Pennsylvania, Philadelphia; Scott North, MD, FRCPC, MHPE, Cross Cancer Institute, Edmonton, Alberta, Canada; Daniel A. Barocas, MD, MPH, FACS, Vanderbilt University Medical Center, Nashville, Tennessee; Petros Grivas, MD, PhD, University of Washington, Seattle, Fred Hutchinson Cancer Center, Seattle, Washington, University of Washington, Seattle; Jorge A. Garcia, MD, Case Comprehensive Cancer Center, Cleveland, Ohio; Andrew J. Stephenson, MD, Rush University, Chicago, Illinois; Jay B. Shah, MD, Stanford University, Palo Alto, California; Siamak Daneshmand, MD, USC/Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles; Philippe E. Spiess, MD, MS, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; Bas W. G. van Rhijn, MD, PhD, Netherlands Cancer Institute, Amsterdam, Caritas St Josef Medical Center, University of Regensburg, Germany; Laura Mertens, MD, Netherlands Cancer Institute, Amsterdam; Peter Black, MD, FACS, FRCSC, University of British Columbia, Vancouver, Canada; Jonathan L. Wright, MD, MS, FACS, University of Washington, Seattle, Fred Hutchinson Cancer Center, Seattle, Washington | Posted on: 18 May 2023

Kirk PS, Lotan Y, Zargar H, et al. Impact of maximal transurethral resection on pathological outcomes at cystectomy in a large, multi-institutional cohort. J Urol. 2023;209(5):882-889.

Study Need and Importance

Pathological findings at radical cystectomy for bladder cancer are known to be predictive of subsequent oncologic outcomes. It is possible that maximal transurethral resection (TUR) of bladder tumors prior to neoadjuvant chemotherapy may help increase rates of pathological response, though possibly at the cost of increased complications. This work aimed to examine the influence of maximal resection on both pathological outcomes at cystectomy as well as subsequent survival outcomes.

What We Found

In this multicenter, retrospective cohort maximal TUR was associated with pathological downstaging at radical cystectomy. Achieving maximal TUR was less common in patients with more advanced cancer. However, maximal TUR was not associated with subsequent overall or cancer-specific survival.

Limitations

These data likely included heterogeneity due to the inclusion of clinical staging and TUR completeness data from referring surgeons prior to cystectomy. This cohort also was lacking in several covariates including postoperative complications after TUR, patient comorbidity, and size of primary bladder tumor.

Interpretation for Patient Care

Maximal TUR may improve rates of pathological response at cystectomy, but the impacts on subsequent survival are unclear. The importance of achieving maximal TUR must also be weighed against surgical risk.

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