Letter to the Editor: Caution Translating Findings in Bladder Cancer Surgery

What is it about?

The study discussed in the letter to the editor found that patients with T1 high-grade bladder cancer following an initial en bloc tumor resection could omit repeat transurethral resection (reTUR). However, the study had methodological and statistical shortcomings, and the recurrence rate of the two groups was similar with statistical nonsignificance. The authors agree that more well-designed studies with larger sample sizes are needed to verify the results, and further analysis revealed that positive surgical margin status was associated with significantly worse recurrence-free survival. The study also highlighted the need for more detail about maintenance therapy and the impact of surgeon experience on clinical outcomes.

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Why is it important?

This research is important because it provides valuable insights into the management of non-muscle-invasive bladder cancer, particularly for patients diagnosed with T1 high-grade bladder cancer following an initial en bloc tumor resection. The study offers valuable information on whether patients can be exempted from repeat transurethral resection (reTUR) and highlights the importance of surgical margin status in determining recurrence-free survival. Key Takeaways: 1. The study suggests that patients with T1 high-grade bladder cancer following an initial en bloc tumor resection may be eligible for omitting repeat transurethral resection (reTUR). 2. The recurrence rate of the two groups (reTUR and no reTUR) was similar, but the recurrence ratio among no reTUR patients with a positive surgical margin was not provided, indicating the need for further investigation. 3. The optimal indication for en bloc resection for bladder tumors (ERBT) has not yet been determined, and its application in daily clinical practice is limited due to technical limitations. 4. Further well-designed studies with larger sample sizes are needed to verify the results and establish more robust conclusions. 5. The impact of surgeon experience on clinical outcomes should be analyzed, and educational programs or surgical checklists for ERBT should be developed.