THE IMPACT OF SURGICAL EXPERIENCE ON THE PRESENCE OF MUSCLE DURING TRANSURETHRAL RESECTION OF THE BLADDER

Background/Aim: Transurethral resection of the bladder (TURBT) is essential in the management of non-muscle invasive bladder cancer (NMIBC) as its quality is associated with the burden of care and oncological outcome. The presence of detrusor muscle (DM) in surgical specimen is a quality of care indicator that predicts staging accuracy and early recurrence. TURBT is a routine procedure that is performed early during the training by residents and young consultants. However, it is well known that standardization, with a systematic and detailed approach are necessary for a high-quality resection. Only few studies evaluated the impact of surgical experience on outcomes of TURBT, without definitive results. Therefore, the aim of our study was to evaluate the impact of surgical experience on the presence of muscle in the specimen during TURBT for bladder cancer. Materials and Methods: Data from patients who underwent TURBT at two tertiary referral centers between 2012 and 2017 were retrospectively assessed. Primary surgeons were divided into three groups based on their surgical experience: residents, young consultants and experienced consultants. A multivariable logistic regression was performed in order to assess the impact of surgical experience on the presence of detrusor muscle in pathologic specimen. Moreover, we evaluated the clinical relevance of our findings by restricting the analyses to T1 patients. A multivariable Cox regression model was built in order to assess the impact of surgical experience on recurrence-free survival (RFS) rate. Results: Overall, 496 patients with complete clinical, pathologic and follow-up data were enrolled in the study. Median follow-up for patients alive at last follow-up was 20 months [interquartile range (IQR)=10-31]. Median age at TURBT was 72 years (IQR=63-78) and 417 (84%) patients were male. DM was in surgical specimen was present in 306 (64%) patients. Considering surgeon experience, DM was present in 144 (59%), 65 (67%), and 97 (70%) of TURBT surgical specimens performed by experienced consultants, young consultants, and residents, respectively. At multivariable logistic regression analysis, that accounts for the effect of standard preoperative factors, surgeon’s experience (residents vs. experienced consultants) was independently associated with the presence of DM [odds ratio (OR)=2.06, 95% confidence interval (CI)=1.16-3.67 p=0.01]. This difference remained significant even when the analyses were restricted to T1