G3T1 Bladder Cancer: Is Early Re-Resection Necessary?:

Summary Objective To review the results of a series of patients with G3 T1 bladder cancer, with specific reference to upstaging at subsequent cystoscopy. Patients and methods One hundred and two patients were identified over a 5-year period, with complete data for 100 regarding original TURBT, early re-resection or 1st check cystoscopy, and subsequent management and outcome. Results Eight patients had primary radical treatment, 32 an early re-resection, 54 BCG and six a routine check cystoscopy. Twenty-one patients had residual Ta/T1 tumour on the first follow up cystoscopy. Only three patients were found to have been originally under-staged. At a mean follow up of 28 months, seven patients had progressed to muscle invasive disease, although 23 had had superficial recurrences. Twenty patients had radical treatment (eight as primary treatment, 12 for BCG ‘failure’). Conclusions An early re-resection may not be necessary for all patients with G3 T1 bladder cancer. Under-staging of these tumours is unusual in our practise, and selection for second-look cystoscopy could be based on review of operative and histological findings at a multidisciplinary clinico-pathology meeting, with a suggestion that T1 sub-classification may have a role in determining the optimum management of this group of patients.