Cautery artifact understages urothelial cancer at initial transurethral resection of large bladder tumours

Authors

  • Matthew Truong University of Rochester School of Medicine and Dentistry, Department of Urology http://orcid.org/0000-0002-0562-6972
  • Lorraine Liang University of Rochester School of Medicine and Dentistry, Department of Urology
  • Janet Kukreja MD Anderson, Department of Urology
  • Jeanne O’Brien
  • Jerome Jean-Gilles University of Rochester School of Medicine and Dentistry, Department of Pathology
  • Edward Messing University of Rochester School of Medicine and Dentistry, Department of Urology

DOI:

https://doi.org/10.5489/cuaj.4172

Abstract

Introduction: We sought to determine how frequently cautery (thermal) artifact precludes an accurate determination of stage at initial transurethral resection of bladder tumour (TURBT) of large bladder tumours.

Methods: We queried our institution’s billing data to identify patients who underwent TURBT for large bladder tumours >5cm (CPT 52240) by two urologists at an academic centre from January 2009 through April 2013. Only patients who underwent initialstaging TURBT for urothelial cancer were included. Pathological reports were reviewed for stage, number of separate pathological specimens per TURBT, and presence of cautery artifact. Operative reports were reviewed for whether additional cold cup biopsies were taken of other suspicious areas of the bladder, resident involvement, and type of electrocautery.

Results: We identified 119 patients who underwent initial staging TURBT for large tumours. Cautery artifact interfered with accurate staging in 7/119 (6%) of cases. Of these, six patients underwent restaging TURBT, with 50% percent experiencing upstaging to T2 disease. Tumour size, tumour grade, whether additional cold cup biopsies were taken, number of separate pathological specimens sent, and resident involvement were not associated with cautery artifact (all p>0.05). Bipolar resection had a higher rate of cautery artifact 5/42 (12%), compared to monopolar resection 2/77 (2.6%) approaching significance (p=0.095).

Conclusions: Cautery artifact may delay accurate staging at initial TURBT for large tumours by understaging up to 6% of patients.

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Author Biography

Matthew Truong, University of Rochester School of Medicine and Dentistry, Department of Urology

Urology resident

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Published

2017-05-09

How to Cite

Truong, M., Liang, L., Kukreja, J., O’Brien, J., Jean-Gilles, J., & Messing, E. (2017). Cautery artifact understages urothelial cancer at initial transurethral resection of large bladder tumours. Canadian Urological Association Journal, 11(5), E203–6. https://doi.org/10.5489/cuaj.4172

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Section

Original Research