title: Impact of surgical experience on recurrence and progression after transurethral resection of bladder tumour in non-muscle-invasive bladder cancer.
abstract: OBJECTIVE
  This study aimed to evaluate the impact of experience in transurethral resection of bladder tumour (TURBT) on recurrence and progression in primary Ta/T1 urinary bladder cancer.
  
  
  METHODS
  Clinical and pathological characteristics of patients with primary Ta/T1 urinary bladder cancer were recorded prospectively from 1992 to 2007 inclusive. Data on surgeons' experience were categorized as follows: experience by training status (residents or specialists); number of TURBTs performed by each surgeon during the registration period, with cut-off levels at more than 100, more than 150, more than 200, greater than the median and above the third quartile of surgical volume; and lifetime high-volume surgeons (>100 TURBTs). Hazard ratios (HRs) were estimated using Cox regression with 95% confidence intervals (CIs) in multivariate analyses.
  
  
  RESULTS
  The analysis included 768 evaluable patients with a median follow-up of 60 months. Recurrence was observed in 478 patients (62%) and progression in 71 (9%). Surgery was performed by residents in 100 cases and specialists in 668, with recurrence in 75 (75%) and 403 (60%) patients, and progression in nine (9%) and 62 (9%), respectively. Surgery performed by specialists was significantly associated with a lower recurrence rate (HR = 0.68, 95% CI 0.53-0.87) but not progression (HR = 0.76, 95% CI 0.37-1.56). Surgical volume had no significant impact on recurrence or progression in any of the analyses at the chosen cut-offs.
  
  
  CONCLUSIONS
  Surgical experience (specialist/resident) was predictive for recurrence after TURBT for Ta/T1 bladder cancer. Training programmes, checklists and specialist-assisted surgery may shorten the learning curve and improve results.
authors.affiliation: Division of Urology, Department of Clinical and Experimental Medicine , Linköping , Sweden.
authors.forename: Georg
authors.initials: G
authors.lastname: Jancke
authors.forename: Johan
authors.initials: J
authors.lastname: Rosell
authors.forename: Staffan
authors.initials: S
authors.lastname: Jahnson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D002983:Clinical Competence; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: TURB; bladder cancer; progression; recurrence; resident; specialist; surgical experience