Introduction:
A single postoperative dose of intravesical chemotherapy (POIC) following transurethral resection of bladder tumors (TURBT) for non-muscle invasive bladder cancer has demonstrated a decrease in tumor recurrence. Despite compelling evidence demonstrating treatment efficacy, it remains underutilized. In this study, we analyze utilization rates and available outcomes of patients receiving POIC following TURBT from a national surgical database.
Methods:
We queried the American College of Surgeons’ National Surgical Quality Improvement Program database to identify all patients undergoing TURBT from 2005-2018. Preoperative characteristics, 30-day postoperative outcomes and 30-day readmission rates stratified by POIC treatment were analyzed. The outcomes included cardiac, pulmonary, renal, infectious, thromboembolic, and bleeding complications; re-operation rates; and prolonged length of stay. Chi-square test, Student’s t-test, and logistic regression were used as appropriate with statistical significance defined as p < 0.05.
Results:
A total of 52407 patients underwent TURBT between 2005-2018 2557 (4.88%) of these patients received POIC. These patients were younger, more likely Caucasian, and have a higher body mass index (all p < 0.05). In addition, they were more likely to have outpatient TURBT, have a shorter operative time, and were less likely to have a large tumor (all p < 0.05). There was no difference in gender, ASA class, frailty index, or smoking status. Patients receiving POIC had a lower 30-day complication rate than those who did not (4.48% vs 7.53%, p < 0.05) - most common complications included sepsis, bleeding, and venous thromboembolic events On multivariable analysis, POIC was associated with lower risk of postoperative complications (OR 0.812, 95% Confidence Interval [CI] 0.667-0.987, p < 0.05). Increased age, increased operative time, ASA Class > 3, and large tumor resection were associated with increased risk of post-operative complications.
Conclusion:
Using a large national surgical database we observed that the utilization of POIC remains low despite current evidence documenting its efficacy in reducing recurrence and incorporation in guidelines. Considering the limitations inherent of this data, the use of POIC appeared safe as it was not associated with an increase in 30-day complication rate, 30-day mortality rate, or return to the operating room in this database. Further studies are needed to validate these findings and support national educational strategies to improve utilization rates of POIC in this population.
Funding: N/A
Image(s) (click to enlarge):
Immediate Postoperative Intravesical Instillation of Chemotherapy after Transurethral Resection of Bladder Tumor: Findings from the National Surgical Quality Improvement Program Database
Category
Bladder Cancer > Non-Muscle Invasive Bladder Cancer
Description
Poster #40
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Presented By: Pratik Kanabur
Authors:
Pratik Kanabur
Guilherme Godoy