A second transurethral resection of the bladder tumor (TURBT) procedure within two to six weeks of an initial TURBT is believed to offer diagnostic, therapeutic, and prognostic improvements to patients with T1 bladder cancer (BC), according to a study in Urologic Oncology. However, lead author, Marian S. Wettstein, and colleagues stated that real-world implementation of re-resection after the guidelines were revised in 2008 is not well-documented. Wettstein and the team examined historical trends and current utilization and reported a varying uptake of TURBT between different groups of surgeons.
The investigators utilized province-wide BC pathology reports in Ontario, Canada from 2001 to 2015. The reports were linked with health administrative data to identify primary cases of T1 BC and to determine whether those patients underwent re-resection. Re-resected patients were then collated into a quarterly time series and evaluated via descriptive analysis, interventional autoregressive moving average (ARIMA) modeling, and Poisson regression analysis.
Among a cohort of 7,363 patients aggregated into a time series, the authors reported a linear increase in the rate of re-resection from 8.4% in 2001 to 28.3% in 2015. Interestingly, the analysis revealed that there was no detectable actual effect of the guideline revision in April 2008 (p = 0.41). However, the authors detected “a rather heterogeneous uptake behavior among different groups of surgeons.” In particular, surgeons that were female, more junior, high-volume, Canadian graduates, or without an academic affiliation were all independently more likely to re-resect their patients (all adjusted p-values <0.05).
The investigators surmised that re-resection rates in primary T1 BC increased between 2001 and 2015 in the province of Ontario, “regardless of the guideline revision in April 2008.” More pressing, though, was the varied uptake of the guideline-endorsed intervention, which the authors recommended warranted further study to identify barriers to uptake that can be specifically addressed.