Surgical Management of Bladder Carcinoma

Rafael Carrion, MD, John Seigne, MB

Disclosures

Cancer Control. 2002;9(4) 

In This Article

The Role of Re-resection

On occasion, the pathologist will have difficulty determining whether the tumor has invaded the muscularis propria. As this is important in determining therapy, these patients need to undergo a re-resection of the base of the tumor. Indeed, an argument has been made that all patients should undergo a second-look cystoscopy and TURBT. In a referral setting, 79% of patients initially diagnosed with superficial bladder tumors were found to have residual tumor at second-look cystoscopy. Upstaging from superficial to invasive bladder cancer occurred in 29% of patients, and management was changed based on the results of the re-resection in 33% of patients.[13] We currently perform office cystoscopy on all patients referred for evaluation of bladder cancer, even if a prior resection was performed elsewhere. However, we re-resect only those with unusual or unexpected findings. We recommend routine re-resection of all patients with high-risk superficial bladder cancer (Ta grade III,T1 grade II-III) as it is in this group that different findings most commonly alter management.

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