title: Value of immediate second resection of the tumor bed to improve the effectiveness of transurethral resection of bladder tumor.
abstract: OBJECTIVE
  Current guidelines recommend routine second transurethral resection (TUR) for accurate diagnosis and to prevent understaging of muscle-invasive bladder cancer. We evaluated the diagnostic accuracy of immediate second resection of the tumor bed during initial TUR and its prognostic significance.
  
  
  METHODS
  Patients (n=126) undergoing TUR were prospectively randomized to undergo (n=63) or not undergo (n=63) immediate second resection of the tumor bed after complete TUR. Second resection was repeated until muscularis propria (MP) was identified in the specimen and the depth of tumor invasion was inspected. The results of second resection were compared with final pathology results for diagnostic accuracy. Recurrence and progression rates were compared in the two groups, and factors affecting recurrence were evaluated.
  
  
  RESULTS
  Patient age, sex distribution, number of tumors, pathologic T stage and grade were similar in the groups. MP was included in all TUR specimens in the immediate second resection group, compared with 41 of 63 (65.1%) in the nonsecond resection group. The concordance rate of second resection with final pathology was r=0.810 (P<0.01). The sensitivity and specificity of second resection for T(2) disease were 90.9% and 98.0%, respectively, and the positive and negative predictive values of second resection for T(2) disease were 90.0% and 96.2%, respectively. Among the 94 patients followed up, those in the second resection group had significantly higher 2-year recurrence-free survival rate (77.0% vs 45.8%, P=0.025), but there was no difference in progression-free survival rate.
  
  
  CONCLUSIONS
  Immediate second resection of the tumor bed after complete TUR improves the effectiveness of resection by immediately confirming the presence of MP in the specimen and accurately differentiating muscle-invasive disease. The advantages of immediate second resection were precise prediction of final pathology results and reduced early recurrence.
authors.affiliation: Department of Urology, Inje University Busan Paik Hospital, Busan, Korea.
authors.forename: Wansuk
authors.initials: W
authors.lastname: Kim
authors.forename: Cheryn
authors.initials: C
authors.lastname: Song
authors.forename: Sejun
authors.initials: S
authors.lastname: Park
authors.forename: Jongwon
authors.initials: J
authors.lastname: Kim
authors.forename: Jinsung
authors.initials: J
authors.lastname: Park
authors.forename: Seong Cheol
authors.initials: SC
authors.lastname: Kim
authors.forename: Yong Mee
authors.initials: YM
authors.lastname: Cho
authors.forename: Bumsik
authors.initials: B
authors.lastname: Hong
authors.forename: Hanjong
authors.initials: H
authors.lastname: Ahn
mesh_terms: D000368:Aged; D003710:Demography; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D001743:Urinary Bladder / Q000473:pathology* / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*