Impact of re-evaluation resection in the treatment of high-grade pT1 bladder tumors: analysis of 43 cases

Abstract Introduction pT1 bladder tumors are considered borderline between NMIBT and MIBT. The aim of this study was to demonstrate the impact of a second resection on the staging, progression, and prognosis of high-grade pT1 bladder tumors. Materials and methods This was a retrospective descriptive and analytical study of 43 patients with high-grade pT1 bladder tumors between 2010 and 2020. Results We collected 43 patient files with high-grade pT1 bladder tumors. The second resection revealed residual tumors in 72% of patients. There was initial understaging in 23% of patients. The delay greater than 6 weeks between the first and second resection as well as the multifocality of the initial tumor were predictive factors for residual tumor (p = 0.009). The median duration of follow-up was 36.5 months with a minimum of 3 months and a maximum of 70 months. Of the 25 patients who had a recurrence during follow-up, the median time to its occurrence was 12 months (range 1–23 months). During follow-up, 25 (58%) of our patients presented with tumor recurrence, including 33% with tumor progression in higher stage. Following the second resection the median time to its occurrence(second look), 23% of our patients underwent radical treatment. The presence of residual tumors at the second resection was predictive of recurrence (p = 0.04) and progression (p = 0.038). Conclusions A second resection is recommended for high-grade pT1 bladder tumors, ideally within a maximum of 6 weeks. It allows the detection of residual tumors in nearly a third of cases and corrects initial understaging in nearly a quarter of cases, and directs the practitioner towards a better therapeutic indication.