Early recurrence after primary TURBT for non-muscle-invasive bladder cancer in Iceland: the critical role of surgical quality
DOI:
https://doi.org/10.2340/sju.v61.45711Keywords:
nonmuscle invasive bladder cancer, early recurrence, surgical qualityAbstract
Introduction: Transurethral resection of bladder tumor (TURBT) is the standard treatment for non-muscle-invasive bladder cancer (NMIBC), but early recurrences remain frequent. The objective of this study was to standardize TURBT management at our institution through the implementation of a treatment protocol designed to reduce early recurrence after primary TURBT.
Material and methods: All patients with newly diagnosed NMIBC who underwent primary TURBT at Landspítali University Hospital between 2013–2015 (control) and 2017–2019 (intervention) were included. The treatment protocol restricted procedures to four surgeons, mandated blue-light cystoscopy, routine postoperative bladder irrigation, and guideline-based instillation therapy. The primary endpoint was recurrence rate at first follow-up cystoscopy; secondary endpoints included adherence to protocol measures and recurrence-free survival.
Results: A total of 133 control and 138 intervention patients were included. Baseline characteristics were comparable. After implementation, bladder irrigation increased from 46 to 90%, blue-light cystoscopy was used in 59% of intervention cases, and instillation therapy rates rose (Mitomycin-C: 0–49% in intermediate-risk; Bacillus Calmette-Guérin (BCG):35–63% in high-risk patients). Early recurrence rates remained comparable (15% vs. 16%). Early recurrence varied markedly between surgeons (11–40%) and correlated strongly with detrusor muscle presence. No significant difference in recurrence-free survival was observed, though a trend toward lower recurrence was seen in the intervention group after adjusting for risk factors.
Conclusion: Implementation of a standardized TURBT protocol improved adherence to recommended measures but did not reduce early recurrence. Marked inter-surgeon variability highlights surgical quality as the key determinant of early recurrence in non-muscle-invasive bladder cancer.
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