Comparison between a Single Dose Intravesical Instillation of Mitomycin-C versus gemcitabine Following Transurethral Resection of Bladder Tumor (TURBT) in Immediate Post-operative Period in Terms of Local Toxicity and Tumor recurrence: A prospective

Background: Bladder cancer is a common malignancy with a high risk of recurrence following transurethral resection of bladder tumors (TURBT). Intravesical chemotherapy, including agents like Gemcitabine and Mitomycin C, is widely used to reduce recurrence rates. However, there is limited comparative data on the efficacy and safety of these two agents in the postoperative setting. Aim and Objective: To evaluate and compare the postoperative recurrence rates and adverse events associated with intravesical Gemcitabine versus Mitomycin C in preventing bladder cancer recurrence. Materials and Methods: A randomized controlled trial was conducted at the Department of Surgery, L.L.R.M. Medical College & associated S.V.B.P. Hospital, Meerut, over a 24-month period. Ninety eligible patients diagnosed with bladder cancer were randomly assigned to receive either intravesical Gemcitabine or Mitomycin C within 24 hours after TURBT, with scheduled follow-up at 3, 6, 9, 12, 18, and 24 months. The primary outcome was time to first recurrence, while secondary outcomes included adverse events and overall patient satisfaction. Statistical analysis was performed using SPSS software, with Kaplan-Meier curves for recurrence-free survival, log-rank tests, and multivariate Cox regression analysis. Results: The study observed a male predominance (65%) in a cohort predominantly aged 61-70 years. A majority of patients had small tumors (2-3 cm). Hypertension and diabetes were the most common comorbidities. At 6 and 12 months, recurrence rates were lower in the Mitomycin C group compared to Gemcitabine. Adverse events such as dysuria, urinary urgency, and cystitis were more frequent in the Mitomycin C group. Postoperative complications, including urinary tract infections and bladder spasms, were noted, but the overall complication rate was low (36.40%). Conclusions: Intravesical treatment with Mitomycin-C post-TURBT shows a potentially in reducing recurrence rates of bladder cancer compared to Gemcitabine, suggesting it as a more favourable treatment option in the early stages of bladder cancer. Both treatments remain viable options for post-TURBT chemotherapy, but Mitomycin-C may offer better outcomes in terms of recurrence prevention and reduced adverse effects.