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.

Department of Maternal Infant and Urologic Sciences 'Sapienza' University of Rome Policlinico Umberto 1 Hospital Rome Italy

Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Urology and Oncological Urology Wrocław Medical University Wrocław Poland

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria

Department of Urology La Croix du Sud Hospital Quint Fonsegrives France

Department of Urology Luzerner Kantonsspital Luzern Switzerland

Department of Urology San Raffaele Hospital and Scientific Institute Milan Italy

Department of Urology Stanford University School of Medicine Stanford CA USA

Department of Urology The Netherlands Cancer Institute Amsterdam The Netherlands

Department of Urology University of Texas Southwestern Dallas TX USA

Department of Urology Weill Cornell Medical College New York NY USA

Hourani Center for Applied Scientific Research Al Ahliyya Amman University Amman Jordan

Section of Pathological Anatomy School of Medicine Polytechnic University of the Marche Region United Hospitals Ancona Italy

Unit of Oncologic Minimally Invasive Urology and Andrology Department of Experimental and Clinical Medicine Careggi Hospital University of Florence Florence Italy

Univ Lille CNRS Inserm CHU Lille Institut Pasteur de Lille UMR9020 U1277 CANTHER Cancer Heterogeneity Plasticity and Resistance to Therapies Lille France

Urology Department Claude Huriez Hospital CHU Lille Lille France

Urology Department Erasme Hospital Université Libre de Bruxelles Brussels Belgium

Urology Division Department of Surgical Sciences University of Studies of Torino Turin Italy

Urology Fundacio Puigvert Barcelona Spain

J Urol. 2024 Jan;211(1):185-186. doi: 10.1097/JU.0000000000003732. PubMed

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