Second resection and prognosis of primary high risk superficial bladder cancer: Is cystectomy often too early?

Purpose: We evaluated the prognostic significance of a second transurethral resection in patients with moderately and poorly differentiated T1 bladder cancer. Materials and Methods: A total of 47 patients with primary T1 bladder cance r were evaluated. A second transurethral resection was performed in 42 pati ents in case of moderately or poorly differentiated T1 bladder tumor or con comitant carcinoma in situ in the first resection. Five patients underwent immediate cystectomy due to large, multifocal and moderately or poorly diff erentiated pT1 disease. Results: Of the 42 patients who underwent repeat resection 15 (36%) had no tumors. Up staging and change of treatment strategy due to the result of th e second resection occurred in 10 (24%) cases. Mean followup was 60 months. An RO second resection correlated with a 33% recurrence rate at followup c ompared with 57%, 75% and 87.5% in patients with pTa, Tis and T1 residual t umor, respectively, in the second resection. The rate of organ preservation was also related to the result of the second resection with 100% organ pre servation in patients with no tumor in the second procedure. After immediat e radical cystectomy 3 of 5 patients died during followup due to disease pr ogression. Of this group 2 patients survived without clinical or radiologic al signs of disease progression. Conclusions: To our knowledge residual tumor after the first transurethral resection is a fact in bladder cancer treatment. The second transurethral r esection offers the possibility to preserve the bladder. Furthermore, resid ual disease can be detected and removed in due time. In case of up staging to muscle infiltrating tumor, cystectomy is the next therapeutic step.