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. 2019;72(4):351-356.
doi: 10.5173/ceju.2019.0003. Epub 2019 Sep 26.

Efficacy of fluorescent cystoscopy-assisted transurethral resection in patients with non-muscle invasive bladder cancer and quality of surgery: post-hoc analysis of а prospective randomized study

Alexander Rolevich  1   2 , Alexander Minich  1 , Vladimir Vasilevich  1 , Alexander Zhegalik  1 , Andrey Mokhort  1 , Tatiana Nabebina  3 , Sergey Krasny  1 , Sergey Polyakov  1 , Oleg Sukonko  1
Affiliations

Efficacy of fluorescent cystoscopy-assisted transurethral resection in patients with non-muscle invasive bladder cancer and quality of surgery: post-hoc analysis of а prospective randomized study

Alexander Rolevich et al. Cent European J Urol. 2019.

Abstract

Introduction: This paper aims to evaluate the influence of quality of transurethral resection in patients with non-muscle invasive bladder cancer on the benefit of fluorescent cystoscopy-assisted transurethral resection in the post hoc analysis of the single-center randomized controlled trial.

Material and methods: We retrospectively analyzed the results of the prospective randomized study assessing the efficacy of fluorescent cystoscopy-assisted transurethral resection. The quality of transurethral resection was defined on the basis of a separate retrospective study estimating the variability in recurrence risk for the individual surgeon. The subgroup analysis of fluorescent cystoscopy-assisted transurethral resection efficacy depending on surgical experience was performed.

Results: Of 377 eligible patients, transurethral resection was performed in 365 (97%) by surgeons with available grading information. Two 'experienced' surgeons performed 238 (63%) of all transurethral resections and three 'less experienced' surgeons completed 127 (34%) surgeries. The two surgical groups were comparable with respect to basic prognostic factors and subsequent therapy. The median follow-up was 56 months.In the total cohort of patients, fluorescent cystoscopy significantly decreased the risk of recurrence with hazard ratio 0.58 (p = 0.004). In the 'experienced surgeons' subgroup the benefit of fluorescent cystoscopy was not significant (hazard ratio 0.81, p = 0.34), whereas the 'less experienced' subgroup showed a marked difference in favor of fluorescent cystoscopy-assisted transurethral resection (hazard ratio 0.31, p = 0.001), with a P-value for interaction of 0.021.

Conclusions: Baseline quality of surgery may be a significant interacting factor affecting the magnitude of the benefit of fluorescent cystoscopy-assisted transurethral resection in patients with non-muscle invasive bladder cancer.

Keywords: cystoscopy; neoplasm recurrence; optical imaging; retrospective studies; urinary bladder neoplasm.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Recurrence-free survival according to fluorescent cystoscopy use in patients operated on by ‘experienced’ surgeons. WL – transurethral resection of bladder tumor in white light; FC – fluorescent cystoscopy-assisted transurethral resection of bladder tumor; D – doxorubicin
Figure 2
Figure 2
Recurrence-free survival according to fluorescent cystoscopy use in patients operated on by ‘less experienced’ surgeons. WL – transurethral resection of bladder tumor in white light; FC – fluorescent cystoscopy-assisted transurethral resection of bladder tumor; D – doxorubicin
See this image and copyright information in PMC

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