Maximal transurethral resection tied to better outcomes at cystectomy

Pathological response at cystectomy may improve with maximal resection in patients undergoing transurethral resection for muscle-invasive bladder cancer prior to neoadjuvant chemotherapy, according to a study.

“While the presence of residual disease at the time of radical cystectomy for bladder cancer is an established prognostic indicator, controversy remains regarding the importance of maximal transurethral resection prior to neoadjuvant chemotherapy,” the authors said.

A total of 785 patients were identified from a multi-institutional cohort undergoing radical cystectomy for muscle-invasive bladder cancer after neoadjuvant chemotherapy. The authors used bivariate comparisons and stratified multivariable models to assess the effect of maximal transurethral resection on pathological findings at cystectomy and survival.

Majority of the patients (n=579, 74 percent) underwent maximal transurethral resection. Patients with more advanced clinical tumour (cT; p<0.001) and nodal (cN; p<0.01) stage had a higher likelihood of having incomplete transurethral resection, with more advanced ypT stage at cystectomy (p<0.01) and higher rates of positive surgical margins (p<0.05).

Multivariable analyses revealed the association of maximal transurethral resection with downstaging at cystectomy (adjusted odds ratio, 1.6, 95 percent confidence interval [CI], 1.1‒2.5). However, maximal transurethral resection did not significantly correlate with overall survival (adjusted hazard ratio, 0.8, 95 percent CI, 0.6‒1.1) in Cox proportional hazards analysis.

“[T]he ultimate effects on long-term survival and oncologic outcomes [of maximal transurethral resection] warrant further investigation,” the authors said.