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Surgical checklist adherence across urology expertise levels impacts transurethral resection of bladder tumour quality indicators |
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| Authors: | Francesco Del Giudice David D'Andrea Benjamin Pradere Florian Berndl Maximilian Pallauf Rocco Simone Flammia Dominik Philipp Marco Moschini Andrea Mari Simone Albisinni Wojciech Krajewski Ekaterina Laukhtina Andrea Gallioli Laura S. Mertens Gautier Marcq Alessia Cimadamore Luca Afferi Paolo Gontero Shahrokh F. Shariat Benjamin I. Chung Francesco Soria |
| Affiliation: | 1. Department of Maternal Infant and Urologic Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I Hospital, Rome, Italy;2. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria;3. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France;4. Department of Urology, San Raffaele Hospital and Scientific Institute, Milan, Italy;5. Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy;6. Urology Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium;7. Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland;8. Urology, Fundacio Puigvert, Barcelona, Spain;9. Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands;10. Urology Department, Claude Huriez Hospital, CHU Lille, Lille, France Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277 – CANTHER – Cancer Heterogeneity Plasticity and Resistance to Therapies, Lille, France;11. Section 12. of Pathological Anatomy, School of Medicine, Polytechnic University of the Marche Region, United Hospitals, Ancona, Italy;13. Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland;14. Urology Division, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy;15. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Department of Urology, Weill Cornell Medical College, New York, NY, USA Department of Urology, University of Texas Southwestern, Dallas, TX, USA Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan;16. Department of Urology, Stanford University School of Medicine, Stanford, CA, USA |
| Abstract: | ObjectivesTo address the association of perioperative surgical checklist across variable surgical expertise with transurethral resection of bladder tumour (TURBT) accuracy and oncological outcomes in non-muscle-invasive bladder cancer.Patients and MethodsWe relied on our prospective collaborative database of patients treated with TURBT between 2012 and 2017. Surgical experience was stratified into three groups: resident vs young vs expert consultants. The association of surgical experience with detrusor muscle (DM) presence and adherence to the standardised peri-procedural nine-items TURBT checklist was evaluated with logistic regression models. A Cox regression model was used to investigate the association of surgical experience with recurrence-free survival (RFS).ResultsA total of 503 patients were available for analysis. TURBT was performed by expert consultants in 265 (52.7%) patients, by young consultants in 149 (29.6%) and by residents in 89 (17.7%). Residents were more likely to have DM in the TURBT specimen than expert consultants (odds ratio [OR] 1.75, 95% confidence interval [CI] 1.03–2.99, P = 0.04). Conversely, no differences in DM presence were seen between young vs expert consultants (OR 1.09, 95% CI 0.71–1.70, P = 0.69). The median checklist completion rate was higher for both residents and young consultants when compared to experts' counterparts (56% and 56% vs 44%, P = 0.009). When focusing on patients receiving a second-look TURBT, the persistent disease was associated with resident status (OR 4.24, 95% CI 1.14–17.70, P = 0.037) at initial TURBT. Surgical experience was not associated with 5-years RFS.ConclusionSurgeon's experience in the case of adequate perioperative surgical checklist implementation was inversely associated with the presence of DM in the specimen but directly linked to higher probability of persistent disease at re-TURBT, although no 5-year RFS differences were noted. |
| Keywords: | non-muscle-invasive bladder cancer transurethral resection of bladder tumour bladder cancer surgical experience resident #BladderCancer #blcsm #uroonc |