title: Good quality white-light transurethral resection of bladder tumours (GQ-WLTURBT) with experienced surgeons performing complete resections and obtaining detrusor muscle reduces early recurrence in new non-muscle-invasive bladder cancer: validation across time and place and recommendation for benchmarking.
abstract: Study Type - Therapy (cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Apart from bladder tumour multiplicity, size, stage, grade and presence of cis, early recurrence following white light TURBT for new bladder tumours is also determined by surgeon experience, completeness of resection and presence or absence of detrusor muscle in the specimen. This study aims to validate surgeon experience and detrusor muscle as independent predictors of early recurrence following apparently complete white light TURBT in new bladder tumours.
  
  
  OBJECTIVE
  To validate in patients undergoing first transurethral resection of bladder tumour (TURBT) for non-muscle-invasive bladder cancer (NMIBC), the presence/absence of detrusor muscle (DM) in the specimen and surgeon experience as independent predictors of the quality of TURBT.
  
  
  METHODS
  Patients with new NMIBC, who had undergone complete first resections were recruited from a prospectively maintained cohort from the 1980s at the Western General Hospital, Edinburgh, UK and a contemporary cohort from the Aberdeen Royal Infirmary, UK.   Tumour size, multiplicity, surgeon category, presence or absence of DM in the specimen, grade, stage, findings at first check cystoscopy and early re-TURBT were evaluated. Surgeons were stratified into a senior group (consultant and trainees in year five or six) and a junior group (trainees below year five). Early recurrence, or recurrence rate at the first follow up cystoscopy (RRFFC), was used to measure quality and was defined as finding pathologically confirmed tumour at early re-TURBT or the first check cystoscopy.
  
  
  RESULTS
  From a total of 566 patients evaluated from both cohorts, 473 NMIBC specimens were suitable for analysis. Logistic regression multivariate analysis revealed that the absence of DM was associated with a higher RRFFC (odds ratio [OR]= 3.6, 95% CI = 1.7-7.5, P < 0.001). Senior surgeons were more likely to resect DM (OR = 4.9, 95% CI = 2.3-10.7, P < 0.001) Senior surgeons were independently associated with a lower RRFFC (OR = 5.3, 95% CI = 2.1-12.9, P < 0.001).
  
  
  CONCLUSIONS
  Detrusor muscle status at the first, apparently complete, TURBT and surgeon's experience independently predict the quality of TURBT. •  Documented complete resection by experienced surgeons with DM presence (good quality white-light TURBT) should be considered a benchmark for white-light TURBT in NMIBC.
authors: Department of Urology, Western General Hospital, Edinburgh, UK. param.mariappan@nhs.net
authors: Paramananthan
authors: P
authors: Mariappan
authors: Steven M
authors: SM
authors: Finney
authors: Elizabeth
authors: E
authors: Head
authors: Bhaskar K
authors: BK
authors: Somani
authors: Alexandra
authors: A
authors: Zachou
authors: Gordon
authors: G
authors: Smith
authors: Said F
authors: SF
authors: Mishriki
authors: James
authors: J
authors: N'Dow
authors: Kenneth M
authors: KM
authors: Grigor
mesh_terms: D000368:Aged; D019985:Benchmarking; D002983:Clinical Competence; D015331:Cohort Studies; D015653:Cystectomy; D003558:Cystoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*