De kwaliteit van de transurethrale resectie van niet-spierinvasieve blaastumoren in het HAGA ziekenhuis

Background and purpose Non muscle invasive bladder cancer (NMIBC) is the most common cancer in the urogenital system. Although the prognosis is good and the mortality is low, the tumor requires a frequent and consistent follow-up because of the high rates of recurrence and progression. Therefore the non muscle invasive bladder tumour has the highest lifetime treatment costs per patients of all cancers. Transurethral resection (TURB) of bladder tumours is the mainstay in the treatment of bladder cancer. However, TURB seems to be related with a high rate of interinstitutional variability in the quality of resection. In this study, the quality of TURB in the HAGA institute was evaluated and compared to the quality as shown in literature. After analyzing the current practice, possible changes in the future practice where evaluated to optimize the quality of TURB in the HAGA institute. Materials and methods In total 142 patients who where diagnosed with a NMIBC in the period january 2006 untill september 2009 were included. A database was created using the quality variables of TURB and the followed treatment regime. The quality of TURB in the HAGA hospital was analysed and compared to the quality as shown in literature. Statistical analysis were done with SPSS. Results Upstaging to a muscle invasive tumour was found in 11.4% of all re-TURB cases, all of whom had a pT1 tumour in the initial resection specimen. Residual tumour at re-TURB or the first follow-up cystoscopy was found in 27.5% of cases. Detrusor muscle was present in 56.3% of TURB specimens, after revision of all re-TURB cases this percentage increased to 64%. The positive predictive value of the surgeon’s documentation about the completeness of the TURB and the positive predictive value of cystoscopies done by a junior surgeon were low. 62.1% of all patients received the postoperative instillation with mitomycine, 20.8% didn’t receive the instillation because of a bladder perforation or persistent hematuria and 17.1% of patients didn’t receive the instillation while no clear reason was described. Discussion and conclusion As described in literature, the most important factors for the measurement of the quality of TURBT are the rate of upstaging to muscle invasive disease, the rate of residual tumour at re-TURB of the first follow-up cystoscopy and the presence of detrusor muscle in the initial resection specimen. Although this is a retrospective study and some aspects of the treatment and diagnostic process could be improved, we can conclude that the quality of TURB as derivative of the described variables is above average in the HAGA hospital as compared to literature