Search

Objectives To 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 Methods We 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). Results A 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. Conclusion Surgeon'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. [ABSTRACT FROM AUTHOR]

Objectives: To develop and validate the Preoperative Risk Evaluation for Partial Nephrectomy (PREP) score to predict the probability of major postoperative complications after partial nephrectomy (PN) based on patient comorbidities. Patients and Methods: The Premier Healthcare Database was used to identify patients who had undergone elective PN. Through review of International Classification of Diseases ninth revision codes, we identified patient comorbidities and major surgical complications (Clavien–Dindo Grade III–V). Multivariable logistic regression was used to identify predictors of major complications. We used half of the set as the training cohort to develop our risk score and the other half as a validation cohort. Results: From 2003 to 2015, 25 451 PNs were performed. The overall rate of major complications was 4.9%. The final risk score consisted of 10 predictors: age, sex, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease, chronic kidney disease, diabetes, hypertension, obesity, and smoking. In the training cohort, the area under the receiver operating characteristic curve (AUC) was 0.75 (95% confidence interval [CI] 0.73–0.78), while the AUC for the validation cohort was 0.73 (95% CI 0.70–0.75). The predicted probabilities of major complication in the low‐ (≤10 points), intermediate‐ (11–20 points), high‐ (21–30 points), and very high‐risk (>30 points) categories were 3% (95% CI 2.6–3.2), 8% (95% CI 7.2–9.2), 24% (95% CI 20.5–27.8), and 41% (95% CI 34.5–47.8), respectively. Conclusions: We developed and validated the PREP score to predict the risk of complications after PN based on patient characteristics. Calculation of the PREP score can help providers select treatment options for patients with a cT1a renal mass and enhance the informed consent process for patients planning to undergo PN. [ABSTRACT FROM AUTHOR]

Background Study Design Endpoints Patients and Methods Trial Registration A second transurethral resection of bladder tumour (Re‐TURBT) is recommended by European Association of Urology (EAU) Guidelines on non‐muscle‐invasive bladder cancers (NMIBCs) due to the risk of understaging and/or persistent disease following the primary resection. However, in many cases this may be unnecessary, potentially harmful, and significantly expensive constituting overtreatment. The CUT‐less trial aims to combine the preoperative staging accuracy of Vesical Imaging‐Reporting and Data System (VI‐RADS) and the intraoperative enhanced ability of photodynamic diagnosis (PDD) to overcome the primary TURBT pitfalls thus potentially re‐defining criteria for Re‐TURBT indications.Single‐centre, non‐inferiority, phase IV, open‐label, randomised controlled trial with 1:1 ratio.The primary endpoint is short‐term BC recurrence between the study arms to assess whether patients preoperatively categorised as VI‐RADS Score 1 and/or Score 2 (i.e., very‐low and low likelihood of MIBC) could safely avoid Re‐TURBT by undergoing primary PDD‐TURBT. Secondary endpoints include mid‐ and long‐term BC recurrences and progression (i–ii). Also, health‐related quality of life (HRQoL) outcomes (iii) and health‐economic cost–benefit analysis (iv) will be performed.All patients will undergo preoperative Multiparametric Magnetic Resonance Imaging of the bladder with VI‐RADS score determination. A total of 327 patients with intermediate‐/high‐risk NMIBCs, candidate for Re‐TURBT according to EAU Guidelines, will be enrolled over a 3‐year period. Participants will be randomised (1:1 ratio) to either standard of care (SoC), comprising primary white‐light (WL) TURBT followed by second WL Re‐TURBT; or the Experimental arm, comprising primary PDD‐TURBT and omitting Re‐TURBT. Both groups will receive adjuvant intravesical therapy and surveillance according to risk‐adjusted schedules. Measure of the primary outcome will be the relative proportion of BC recurrences between the SoC and Experimental arms within 4.5 months (i.e., any ‘early’ recurrence detected at first follow‐up cystoscopy). Secondary outcomes measures will be the relative proportion of late BC recurrences and/or BC progression detected after 4.5 months follow‐up. Additionally, we will compute the HRQoL variation from NMIBC questionnaires modelled over a patient lifetime horizon and the health‐economic analyses including a short‐term cost–benefit assessment of incremental costs per Re‐TURBT avoided and a longer‐term cost‐utility per quality‐adjusted life year gained using 2‐year clinical outcomes to drive a lifetime model across the two arms of treatment.ClinicalTrial.gov identifier (ID): NCT05962541; European Union Drug Regulating Authorities Clinical Trials Database (EudraCT) ID: 2023‐507307‐64‐00. [ABSTRACT FROM AUTHOR]