Surgical checklist adherence across urology expertise levels impacts transurethral resection of bladder tumour quality indicators
Del Giudice, Francesco (Stanford University School of Medicine (Estats Units d'Amèrica))
D'Andrea, David (Medical University of Vienna)
Pradere, Benjamin (La Croix du Sud Hospital (Quint Fonsegrives, França))
Berndl, Florian (Medical University of Vienna)
Pallauf, Maximilian (Medical University of Vienna)
Flammia, Rocco Simone (Policlinico Umberto I Hospital (Itàlia))
Philipp, Dominik (Medical University of Vienna)
Moschini, Marco (San Raffaele Hospital and Scientific Institute (Itàlia))
Mari, Andrea (Università degli Studi di Firenze)
Albisinni, Simone (Université Libre de Bruxelles (Bèlgica))
Krajewski, Wojciech (Wrocław Medical University (Polònia))
Laukhtina, Ekaterina (Medical University of Vienna)
Gallioli, Andrea (Institut d'Investigació Biomèdica Sant Pau)
Mertens, Laura S. (Netherlands Cancer Institute (Països Baixos))
Marcq, Gautier (Institut Pasteur de Lille)
Cimadamore, Alessia (United Hospitals (Itàlia))
Afferi, Luca (Luzerner Kantonsspital (Suïssa))
Gontero, Paolo (Università degli Studi di Torino (Torí, Itàlia))
Shariat, Shahrokh (Al-Ahliyya Amman University (Jordània))
Chung, Benjamin I. (Stanford University School of Medicine (Estats Units d'Amèrica))
Soria, Francesco (University of Studies of Torino (Itàlia))
Universitat Autònoma de Barcelona

Fecha:	2023
Resumen:	To address the association of perioperative surgical checklist across variable surgical expertise with transurethral resection of bladder tumour (TURBT) accuracy and oncological outcomes in non-muscle-invasive bladder cancer. We relied on our prospective collaborative database of patients treated with TURBT between 2012 and 2017. Surgical experience was stratified into three groups: resident vs young vs expert consultants. The association of surgical experience with detrusor muscle (DM) presence and adherence to the standardised peri-procedural nine-items TURBT checklist was evaluated with logistic regression models. A Cox regression model was used to investigate the association of surgical experience with recurrence-free survival (RFS). A total of 503 patients were available for analysis. TURBT was performed by expert consultants in 265 (52. 7%) patients, by young consultants in 149 (29. 6%) and by residents in 89 (17. 7%). Residents were more likely to have DM in the TURBT specimen than expert consultants (odds ratio [OR] 1. 75, 95% confidence interval [CI] 1. 03-2. 99, P = 0. 04). Conversely, no differences in DM presence were seen between young vs expert consultants (OR 1. 09, 95% CI 0. 71-1. 70, P = 0. 69). The median checklist completion rate was higher for both residents and young consultants when compared to experts' counterparts (56% and 56% vs 44%, P = 0. 009). When focusing on patients receiving a second-look TURBT, the persistent disease was associated with resident status (OR 4. 24, 95% CI 1. 14-17. 70, P = 0. 037) at initial TURBT. Surgical experience was not associated with 5-years RFS. Surgeon's experience in the case of adequate perioperative surgical checklist implementation was inversely associated with the presence of DM in the specimen but directly linked to higher probability of persistent disease at re-TURBT, although no 5-year RFS differences were noted.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	#BladderCancer ; #blcsm ; #uroonc ; Bladder cancer ; Non-muscle-invasive bladder cancer ; Resident ; Surgical experience ; Transurethral resection of bladder tumour
Publicado en:	BJU International, Vol. 131 Núm. 6 (june 2023) , p. 712-719, ISSN 1464-410X

DOI: 10.1111/bju.15920
PMID: 36251366

8 p, 702.1 KB

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