Volume : V, Issue : III, May - 2021
Background: Transurethral resection (TUR) of bladder tumours is not only mandatory for adequate staging but also crucial in delaying or preventing tumour recurrence and progression. Objective: To evaluate the impact of routine second TUR on the long-term outcome of patients with newly diagnosed pT1 urothelial carcinoma. Methods: This prospectively randomized Trial was conducted in urology department of BSMMU, Dhaka, Bangladesh from January 2017 and January 2020. Two hundred ten newly diagnosed T1 bladder cancer patients were prospectively randomized to two groups between January 2017 and January 2020. Second TUR was performed within 26 wk. after the initial resection for the patients of group 1. Second TUR was not done in group 2. All patients (groups 1 and 2) received the first instillation of intravesical chemotherapy within 24 h after the initial resection. Urine cytology and follow-up cystoscopy were performed at 3-mo intervals for the first year, biannually for the second year, and annually thereafter. All patients were followed until death or a minimum of 54 months. Results: The mean follow-up period was 66.1 months without a significant difference between the groups. Residual tumour was detected histopathologically in 35 of 105 patients in group 1. Of these patients, eight had upper-stage (pT2) disease. Recurrence was observed in 37 of the 93 patients in group 1 and 70 of the 98 patients in group 2. Median recurrence-free survival was 47 months for group 1 compared with 12 months for group 2. Progression was observed in 6.5% of patients for group 1 compared to 23.5% of patients for group 2 (p = 0.001). Median progress-free survival was 73 months for group 1 compared to 53.5 months for group 2. The overall survival rate was 67.7% and 64.3% in groups 1 and 2, respectively (log rank test result: 0.363). Only 5 of the 30 patients in group 1 died of cancer compared to 11 of the 35 patients in group 2 (p=0.038). Conclusions: We have clearly shown that second TUR, which is performed only after complete first TUR, has significantlydecreasedtherecurrenceandprogressionratesinpatientswithnewly diagnosed T1 disease compared to patients with T1 disease but with no second TUR. This study once more underscores the effect of TUR, which is usually underappreciated.
IMPACT OF ROUTINE SECOND TRANSURETHRAL RESECTION ON THE LONG-TERM OUTCOME OF PATIENTS WITH NEWLY DIAGNOSED PT1 UROTHELIAL CARCINOMA, Md. Sayedul Islam, Md. Shafiqur Rahman, Md. Shamim Hossain, A. S. M. Shafiul Azam, Md. Salauddin Faruque, Md. Saiful Islam, INTERNATIONAL JOURNAL OF ADVANCED MEDICINE : Volume-5 | Issue-3 | May-2021