title: The clinical significance of a second transurethral resection for T1 high-grade bladder cancer: Results of a prospective study.
abstract: OBJECTIVE
  This study was designed to estimate the value of a second transurethral resection of bladder tumor (TURBT) procedure in patients with initially diagnosed T1 high-grade bladder cancer.
  
  
  METHODS
  Between August 2009 and January 2013, a total of 29 patients with T1 high-grade bladder cancer prospectively underwent a second TURBT procedure. Evaluation included the presence of previously undetected residual tumor, changes to histopathological staging or grading, and tumor location. Recurrence-free and progression-free survival curves were generated to compare the prognosis between the groups with and without residual lesions by use of the Kaplan-Meier method.
  
  
  RESULTS
  Of 29 patients, 22 patients (75.9%) had residual disease after the second TURBT. Staging was as follows: no tumor, 7 (24.1%); Ta, 5 (17.2%); T1, 6 (20.7%); Tis, 6 (20.7%); Ta+Tis, 1 (3.4%); T1+Tis, 1 (3.4%); and ≥T2, 3 (10.3%). The muscle layer was included in the surgical specimen after the initial TURBT in 24 patients (82.7%). In three patients whose cancer was upstaged to pT2 after the second TURBT, the initial surgical specimen contained the muscle layer. In the group with residual lesions, the 3-year recurrence-free survival and 3-year progression-free survival rates were 50% and 66.9%, respectively, whereas these rates were 68.6% and 68.6%, respectively, in the group without residual lesions. This difference was not statistically significant.
  
  
  CONCLUSIONS
  Initial TURBT does not seem to be enough to control T1 high-grade bladder cancer. Therefore, a routine second TURBT procedure should be recommended in patients with T1 high-grade bladder cancer to accomplish adequate tumor resection and to identify patients who may need to undergo prompt cystectomy.
authors.affiliation: Department of Urology, Korea University Ansan Hospital, Ansan, Korea.
authors.forename: Ji Sung
authors.initials: JS
authors.lastname: Shim
authors.affiliation: Department of Urology, Korea University Ansan Hospital, Ansan, Korea.
authors.forename: Hoon
authors.initials: H
authors.lastname: Choi
authors.affiliation: Department of Urology, Korea University Ansan Hospital, Ansan, Korea.
authors.forename: Tae Il
authors.initials: TI
authors.lastname: Noh
authors.affiliation: Department of Urology, Korea University Anam Hospital, Seoul, Korea.
authors.forename: Jong Hyun
authors.initials: JH
authors.lastname: Tae
authors.affiliation: Department of Urology, Korea University Anam Hospital, Seoul, Korea.
authors.forename: Sung Goo
authors.initials: SG
authors.lastname: Yoon
authors.affiliation: Department of Urology, Korea University Anam Hospital, Seoul, Korea. ; Department of Urology, Korea University College of Medicine, Seoul, Korea.
authors.forename: Seok Ho
authors.initials: SH
authors.lastname: Kang
authors.affiliation: Department of Urology, Korea University Ansan Hospital, Ansan, Korea. ; Department of Urology, Korea University College of Medicine, Seoul, Korea.
authors.forename: Jae Hyun
authors.initials: JH
authors.lastname: Bae
authors.affiliation: Department of Urology, Korea University College of Medicine, Seoul, Korea. ; Department of Urology, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Hong Seok
authors.initials: HS
authors.lastname: Park
authors.affiliation: Department of Urology, Korea University Ansan Hospital, Ansan, Korea. ; Department of Urology, Korea University College of Medicine, Seoul, Korea.
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Park
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000379:methods; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D011379:Prognosis; D011446:Prospective Studies; D012086:Reoperation / Q000379:methods; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Neoplasm invasiveness; Recurrence; Urinary bladder neoplasms