Impact of Maximal Transurethral Resection on Pathological Outcomes at Cystectomy in a Large, Multi-institutional Cohort

Peter S. Kirk; Yair Lotan; Homayoun Zargar; Kamran  Zargar; Adrian S Fairey; Colin P Dinney; Maria C Mir; Laura-Maria Krabbe; Michael S Cookson; Niels-Erik  Jacobson; Jeffrey S Montgomery; Nikhil Vasdev; Evan Y Yu; Evanguelos Xylinas; Wassim Kassouf; Marc A Dall'Era; Srikala S. Sridhar; Jonathan S McGrath; Jonathan Aning; Shahrokh F Shariat; Andrew C. Thorpe; Todd M Morgan; Jeff M Holzbeierlein; Trinity J Bivalacqua; Scott North; Daniel A Barocas; Petros Grivas; Jorge A Garcia; Andrew J Stephenson; Jay B Shah; Siamek  Daneshmand; Philippe E Spiess; Bas WG  van Rhijn; Peter C. Black; Jonathan L. Wright

doi:10.1097/JU.0000000000003193

Impact of Maximal Transurethral Resection on Pathological Outcomes at Cystectomy in a Large, Multi-institutional Cohort

Peter S. Kirk, Yair Lotan, Homayoun Zargar, Kamran Zargar, Adrian S Fairey, Colin P Dinney, Maria C Mir, Laura-Maria Krabbe, Michael S Cookson, Niels-Erik Jacobson, Jeffrey S Montgomery, Nikhil Vasdev, Evan Y Yu, Evanguelos Xylinas, Wassim Kassouf, Marc A Dall'Era, Srikala S. Sridhar, Jonathan S McGrath, Jonathan Aning, Shahrokh F ShariatAndrew C. Thorpe, Todd M Morgan, Jeff M Holzbeierlein, Trinity J Bivalacqua, Scott North, Daniel A Barocas, Petros Grivas, Jorge A Garcia, Andrew J Stephenson, Jay B Shah, Siamek Daneshmand, Philippe E Spiess, Bas WG van Rhijn, Peter C. Black, Jonathan L. Wright

Research output: Contribution to journal › Article › peer-review

Abstract

Purpose: While the presence of residual disease at the time of radical cystectomy for bladder cancer is an established prognostic indicator, controversy remains regarding the importance of maximal transurethral resection prior to neoadjuvant chemotherapy. We characterized the influence of maximal transurethral resection on pathological and survival outcomes using a large, multi-institutional cohort.
Materials and Methods: We identified 785 patients from a multi-institutional cohort undergoing radical cystectomy for muscle-invasive bladder cancer after neoadjuvant chemotherapy. We employed bivariate comparisons and stratified multivariable models to quantify the effect of maximal transurethral resection on pathological findings at cystectomy and survival.
Results: Of 785 patients, 579 (74%) underwent maximal transurethral resection. Incomplete transurethral resection was more frequent in patients with more advanced clinical tumor (cT) and nodal (cN) stage (P Conclusions: In patients undergoing transurethral resection for muscle-invasive bladder cancer prior to neoadjuvant chemotherapy, maximal resection may improve pathological response at cystectomy. However, the ultimate effects on long-term survival and oncologic outcomes warrant further investigation.

Original language	English
Pages (from-to)	882-889
Number of pages	8
Journal	AUA Journal of Urology
Volume	209
Issue number	5
Early online date	16 Feb 2023
DOIs	https://doi.org/10.1097/JU.0000000000003193
Publication status	Published - 1 May 2023

Keywords

cystectomy
margins of excision
neoplasm staging
urinary bladder neoplasms

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Kirk, P. S., Lotan, Y., Zargar, H., Zargar, K., Fairey, A. S., Dinney, C. P., Mir, M. C., Krabbe, L.-M., Cookson, M. S., Jacobson, N.-E., Montgomery, J. S., Vasdev, N., Yu, E. Y., Xylinas, E., Kassouf, W., Dall'Era, M. A., Sridhar, S. S., McGrath, J. S., Aning, J., ... Wright, J. L. (2023). Impact of Maximal Transurethral Resection on Pathological Outcomes at Cystectomy in a Large, Multi-institutional Cohort. AUA Journal of Urology, 209(5), 882-889. https://doi.org/10.1097/JU.0000000000003193

@article{1813d2b8b86342bd917f5d0fc0dc17ed,

title = "Impact of Maximal Transurethral Resection on Pathological Outcomes at Cystectomy in a Large, Multi-institutional Cohort",

abstract = "Purpose: While the presence of residual disease at the time of radical cystectomy for bladder cancer is an established prognostic indicator, controversy remains regarding the importance of maximal transurethral resection prior to neoadjuvant chemotherapy. We characterized the influence of maximal transurethral resection on pathological and survival outcomes using a large, multi-institutional cohort.Materials and Methods: We identified 785 patients from a multi-institutional cohort undergoing radical cystectomy for muscle-invasive bladder cancer after neoadjuvant chemotherapy. We employed bivariate comparisons and stratified multivariable models to quantify the effect of maximal transurethral resection on pathological findings at cystectomy and survival.Results: Of 785 patients, 579 (74%) underwent maximal transurethral resection. Incomplete transurethral resection was more frequent in patients with more advanced clinical tumor (cT) and nodal (cN) stage (P Conclusions: In patients undergoing transurethral resection for muscle-invasive bladder cancer prior to neoadjuvant chemotherapy, maximal resection may improve pathological response at cystectomy. However, the ultimate effects on long-term survival and oncologic outcomes warrant further investigation.",

keywords = "cystectomy, margins of excision, neoplasm staging, urinary bladder neoplasms",

author = "Kirk, {Peter S.} and Yair Lotan and Homayoun Zargar and Kamran Zargar and Fairey, {Adrian S} and Dinney, {Colin P} and Mir, {Maria C} and Laura-Maria Krabbe and Cookson, {Michael S} and Niels-Erik Jacobson and Montgomery, {Jeffrey S} and Nikhil Vasdev and Yu, {Evan Y} and Evanguelos Xylinas and Wassim Kassouf and Dall'Era, {Marc A} and Sridhar, {Srikala S.} and McGrath, {Jonathan S} and Jonathan Aning and Shariat, {Shahrokh F} and Thorpe, {Andrew C.} and Morgan, {Todd M} and Holzbeierlein, {Jeff M} and Bivalacqua, {Trinity J} and Scott North and Barocas, {Daniel A} and Petros Grivas and Garcia, {Jorge A} and Stephenson, {Andrew J} and Shah, {Jay B} and Siamek Daneshmand and Spiess, {Philippe E} and {van Rhijn}, {Bas WG} and Black, {Peter C.} and Wright, {Jonathan L.}",

note = "{\textcopyright} 2023 by American Urological Association Education and Research, Inc. This is the accepted manuscript version of an article which has been published in final form at https://doi.org/10.1097/JU.0000000000003193",

year = "2023",

month = may,

day = "1",

doi = "10.1097/JU.0000000000003193",

language = "English",

volume = "209",

pages = "882--889",

journal = "AUA Journal of Urology",

publisher = "American Urological Association (AUA)",

number = "5",

}

Kirk, PS, Lotan, Y, Zargar, H, Zargar, K, Fairey, AS, Dinney, CP, Mir, MC, Krabbe, L-M, Cookson, MS, Jacobson, N-E, Montgomery, JS, Vasdev, N, Yu, EY, Xylinas, E, Kassouf, W, Dall'Era, MA, Sridhar, SS, McGrath, JS, Aning, J, Shariat, SF, Thorpe, AC, Morgan, TM, Holzbeierlein, JM, Bivalacqua, TJ, North, S, Barocas, DA, Grivas, P, Garcia, JA, Stephenson, AJ, Shah, JB, Daneshmand, S, Spiess, PE, van Rhijn, BWG, Black, PC & Wright, JL 2023, 'Impact of Maximal Transurethral Resection on Pathological Outcomes at Cystectomy in a Large, Multi-institutional Cohort', AUA Journal of Urology, vol. 209, no. 5, pp. 882-889. https://doi.org/10.1097/JU.0000000000003193

TY - JOUR

T1 - Impact of Maximal Transurethral Resection on Pathological Outcomes at Cystectomy in a Large, Multi-institutional Cohort

AU - Kirk, Peter S.

AU - Lotan, Yair

AU - Zargar, Homayoun

AU - Zargar, Kamran

AU - Fairey, Adrian S

AU - Dinney, Colin P

AU - Mir, Maria C

AU - Krabbe, Laura-Maria

AU - Cookson, Michael S

AU - Jacobson, Niels-Erik

AU - Montgomery, Jeffrey S

AU - Vasdev, Nikhil

AU - Yu, Evan Y

AU - Xylinas, Evanguelos

AU - Kassouf, Wassim

AU - Dall'Era, Marc A

AU - Sridhar, Srikala S.

AU - McGrath, Jonathan S

AU - Aning, Jonathan

AU - Shariat, Shahrokh F

AU - Thorpe, Andrew C.

AU - Morgan, Todd M

AU - Holzbeierlein, Jeff M

AU - Bivalacqua, Trinity J

AU - North, Scott

AU - Barocas, Daniel A

AU - Grivas, Petros

AU - Garcia, Jorge A

AU - Stephenson, Andrew J

AU - Shah, Jay B

AU - Daneshmand, Siamek

AU - Spiess, Philippe E

AU - van Rhijn, Bas WG

AU - Black, Peter C.

AU - Wright, Jonathan L.

N1 - © 2023 by American Urological Association Education and Research, Inc. This is the accepted manuscript version of an article which has been published in final form at https://doi.org/10.1097/JU.0000000000003193

PY - 2023/5/1

Y1 - 2023/5/1

N2 - Purpose: While the presence of residual disease at the time of radical cystectomy for bladder cancer is an established prognostic indicator, controversy remains regarding the importance of maximal transurethral resection prior to neoadjuvant chemotherapy. We characterized the influence of maximal transurethral resection on pathological and survival outcomes using a large, multi-institutional cohort.Materials and Methods: We identified 785 patients from a multi-institutional cohort undergoing radical cystectomy for muscle-invasive bladder cancer after neoadjuvant chemotherapy. We employed bivariate comparisons and stratified multivariable models to quantify the effect of maximal transurethral resection on pathological findings at cystectomy and survival.Results: Of 785 patients, 579 (74%) underwent maximal transurethral resection. Incomplete transurethral resection was more frequent in patients with more advanced clinical tumor (cT) and nodal (cN) stage (P Conclusions: In patients undergoing transurethral resection for muscle-invasive bladder cancer prior to neoadjuvant chemotherapy, maximal resection may improve pathological response at cystectomy. However, the ultimate effects on long-term survival and oncologic outcomes warrant further investigation.

AB - Purpose: While the presence of residual disease at the time of radical cystectomy for bladder cancer is an established prognostic indicator, controversy remains regarding the importance of maximal transurethral resection prior to neoadjuvant chemotherapy. We characterized the influence of maximal transurethral resection on pathological and survival outcomes using a large, multi-institutional cohort.Materials and Methods: We identified 785 patients from a multi-institutional cohort undergoing radical cystectomy for muscle-invasive bladder cancer after neoadjuvant chemotherapy. We employed bivariate comparisons and stratified multivariable models to quantify the effect of maximal transurethral resection on pathological findings at cystectomy and survival.Results: Of 785 patients, 579 (74%) underwent maximal transurethral resection. Incomplete transurethral resection was more frequent in patients with more advanced clinical tumor (cT) and nodal (cN) stage (P Conclusions: In patients undergoing transurethral resection for muscle-invasive bladder cancer prior to neoadjuvant chemotherapy, maximal resection may improve pathological response at cystectomy. However, the ultimate effects on long-term survival and oncologic outcomes warrant further investigation.

KW - cystectomy

KW - margins of excision

KW - neoplasm staging

KW - urinary bladder neoplasms

UR - http://www.scopus.com/inward/record.url?scp=85152172530&partnerID=8YFLogxK

U2 - 10.1097/JU.0000000000003193

DO - 10.1097/JU.0000000000003193

M3 - Article

VL - 209

SP - 882

EP - 889

JO - AUA Journal of Urology

JF - AUA Journal of Urology

IS - 5

ER -

Impact of Maximal Transurethral Resection on Pathological Outcomes at Cystectomy in a Large, Multi-institutional Cohort

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