Surgeon has a major impact on long-term recurrence risk in patients with non-muscle invasive bladder cancer

Introduction: One of the factors responsible for the risk of recurrence after complete transurethral resection of the bladder tumor (TURBT) in patients with non-muscle invasive bladder cancer (NMIBC) is the quality of surgery that may vary between individual surgeons. The aim of the study was to evaluate the impact of the surgeon on recurrence-free survival in patients with NMIBC.

Material and methods: The long-term results of a series of consecutive TURBTs performed by five staff urologists at a single institution were retrospectively analyzed. A total of 949 cases of organ-preserving treatment in 784 patients with NMIBC were included in the analysis.

Results: With the median follow-up of 64.3 months (3-124 months), the 5-year recurrence-free survival rates according to the surgeon were 62.9% (95% CI 56.2-69.7%), 53.6% (95% CI 47.4-59.9%), 51.0% (95% CI 39.6-62.4%), 46.2% (95% CI 36.4-56.0%), and 44.2% (95% CI 36.8-51.7%), respectively (p <0.0001). In the multivariate analysis including all potential risk factors, the individual surgeon was associated with a risk of recurrence with a high degree of statistical significance (p = 0.0013). The between-surgeon differences in the recurrence risk were not that pronounced in less extensive tumors.

Conclusions: A surgeon has a significant impact on the risk of recurrence after curative treatment of patients with NMIBC. This effect was observed despite the relatively extensive experience in bladder endoscopic surgery of all of the surgeons and practicing in a setting of one specialized center. These findings should be taken into account while performing and evaluating the results of comparative studies.