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. 2021 May 25;7(2):193-203.
doi: 10.3233/BLC-201515. eCollection 2021.

Low Risk of Severe Complications After a Single, Post-Operative Instillation of Intravesical Chemotherapy in Patients with TaG1G2 Urothelial Bladder Carcinoma

Lisa M C van Hoogstraten  1 , J Alfred Witjes  2 , Theodora M Ripping  1 , Ronald I Nooter  3 , Lambertus A Kiemeney  2   4 , Katja K H Aben  1   4 ; BlaZIB study group
Affiliations

Low Risk of Severe Complications After a Single, Post-Operative Instillation of Intravesical Chemotherapy in Patients with TaG1G2 Urothelial Bladder Carcinoma

Lisa M C van Hoogstraten et al. Bladder Cancer. .

Abstract

Background: EAU guidelines recommend a single instillation (SI) of intravesical chemotherapy (e.g. Mitomycin C) within 24 hours after transurethral resection of a bladder tumour (TURBT) in patients with low- to intermediate risk non-muscle invasive bladder cancer without (suspected) bladder perforation or bleeding requiring bladder irrigation. However, remarkable variation exists in the use of SI. The risk of severe complications is likely to contribute to this variation, but evidence is limited.

Objective: To investigate the absolute severe complication and mortality risk after SI in low- and intermediate risk bladder cancer.

Methods: In this observational, historic cohort study, data on 25,567 patients diagnosed with TaG1G2 urothelial bladder carcinoma (UBC) between 2009 and 2018 who underwent TURBT were collected from the Netherlands Cancer Registry. Data were supplemented with information on cause of death and severe complications after cancer treatment by re-examining the electronic health records and the 14-day complication risk and the 30-day mortality risk were evaluated.

Results: On average, 55% of patients had a SI after TURBT, varying from 0->80% between hospitals. The 30-day mortality risk was 0.02% and the 14-day risk of severe complications was 1.6%.

Conclusions: As the absolute risk of mortality and severe complications is very low, SI after TURBT can be considered a safe treatment in patients with low- to intermediate UBC without contraindications for SI. These results imply that a part of eligible patients is denied effective treatment.

Keywords: NMIBC; Non-muscle invasive bladder cancer; complications; intravesical instillation; treatment guidelines; urothelial carcinoma; variation in healthcare.

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Conflict of interest statement

Lisa M.C. van Hoogtraten, J. Alfred Witjes, Theodora M. Ripping, Ronald I. Nooter, Lambertus A. Kiemeney, Katja K.H. Aben and the BlaZIB study group have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Flowchart describing the inclusion of patients in the study cohort TURBT: Transurethral Resection of the Bladder Tumour; SI: Single Instillation.
Fig. 2
Fig. 2
Percentage of patients diagnosed in 2017-2018 with TaG1G2 urothelial carcinoma receiving a SI per province in the Netherlands SI: Single Instillation.
Fig. 3
Fig. 3
Percentage of patients diagnosed in 2017-2018 with TaG1G2 urothelial carcinoma receiving a SI by hospital volume in 2017-2018 in the Netherlands SI: Single Instillation *Hospital volume was based on the number of patients with TaG1G2 treated with transurethral resection of the bladder tumour (TURBT). Hospitals with < 10 patients were excluded from the analysis.
See this image and copyright information in PMC

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