TURBT for Treatment of Recurrent High Risk Superficial or Muscle-Invasive Bladder Tumours: Factors Contributing to T0 Radical Cystectomy Specimens

Objective: To identify factors that could potentially result in a final pathology stage pT0 after radical cystectomy, with the aim to promote bladder preservation techniques for certain patients with recurrent high grade superficial or muscle invasive bladder cancer.

Materials and Methods: 250 patients underwent radical cystectomy in our institution over 7 years (January 2006-December 2012). A thorough analysis of the patients’ files with no residual tumour on the cystectomy specimen (pT0) was performed. Possible factors contributing to such a result were described within a detailed literature review context.

Results: Overall fourteen (5.6%) patients had a pT0 stage after radical cystectomy. Twelve patients had transitional cell carcinoma (one with squamous and one with sarcomatoid differentiation). One patient had squamous cell carcinoma and another had adenocarcinoma of the bladder. None of the tumours presented lymphovascular invasion on the transurethral resection specimen. All fourteen patients are still alive with no signs of recurrence. Four factors were predominant in all our T0 cystectomy patients.

Conclusion: We identified four independent factors which potentially could have contributed towards a pT0 cystectomy result. These included the completeness of transurethral resection, the experience of the surgeon, the application of a standardized technique for transurethral resection and the absence of lymphovascular invasion on the TURBT specimen.

Keywords: transurethral resection of bladder; cystectomy; urinary bladder neoplasm.