SRS288 - Timing of re-resection following initial TURBT in high-risk non-muscle invasive bladder cancer: a retrospective review

Abstract Introduction/Background Transurethral resection of bladder tumour (TURBT) is the standard first-line surgical treatment for bladder cancer. International guidelines from the European Association of Urology (EAU), American Urological Association (AUA), and NICE recommend re-resection within 2–6 weeks for high-risk non-muscle-invasive bladder cancer (NMIBC) or incomplete initial resections, to eliminate residual tumour and minimise understaging. Literature suggests that approximately 4.8% of tumours are upstaged at re-resection. This study aimed to assess adherence to these guidelines at a district general hospital. Methods A retrospective review of 122 operation notes and histology reports was conducted. Data collected included patient demographics, histopathology, and timing of multi-disciplinary team (MDT) discussions and re-resection procedures. Results Re-resection was indicated in 28.7% of cases. Only 8.6% of patients underwent re-resection within the recommended 6-week timeframe. The mean interval between initial TURBT and re-resection was 62.7 ± 26.9 days. The average time from TURBT to MDT discussion was 13.7 ± 10.5 days, and from MDT to re-resection was 49.0 ± 25.0 days. Tumour upgrading on histology was observed in 8.6% of re-resected cases. Among patients who required re-resection, 42.9% had initial operative findings suggestive of higher-grade disease. Conclusions Adherence to re-resection guidelines was low, highlighting a potential contributor to the higher rate of tumour upstaging observed compared to published data. Modifying the TURBT operative note template to prompt surgeons to request re-resection at the time of initial surgery, when high-grade features are identified may help improve conformity to guidelines.