The impact of early re-resection in patients with pT1 high-grade non-muscle invasive bladder cancer

AIM: To evaluate the impact of early re-resection on the incidence of tumour recurrence and progression in patients with pT1 high-grade non-muscle invasive bladder cancer (HG-NMIBC). PATIENTS AND METHODS: From 2001 to 2008, 486 consecutive patients were diagnosed with pT1 HG-NMIBC. Data were collected retrospectively which included patient demographics, histological parameters including the presence of detrusor muscle at initial TUR and at re-resection, adjuvant intravesical therapy, and recurrence and progression rates. Early re-resection was performed within six weeks of initial TUR. Patients comprised those who underwent an early re-resection (Group A, n = 172) and those who did not (Group B, n = 314). RESULTS: At initial TUR, detrusor muscle was present in 61% (n = 105) of patients in Group A and 76% (n = 240) of patients in Group B. At early re-resection, detrusor muscle was present in 77.9% of cases. A residual tumour was present in 54.6% of re-resected cases. The overall incidence of tumour recurrence was 35% and 42% in Groups A and B, respectively. During follow-up, there was a significantly higher rate of tumour stage progression in patients who did not undergo early re-resection (Group B 14.4% vs. Group A 3.3%, P < 0.05). CONCLUSIONS: Early re-resection facilitates accurate staging and clearance of residual disease. Subsequent rates of tumour stage progression are significantly improved. We advocate early re-resection for all patients with HG-NMIBC.