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The following is a summary of “Clinical impact of detrusor muscle in en bloc resection for T1 bladder cancer,” published in the December 2023  issue of Urology by Yanagisawa, et al.

A quality-of-care standard is the presence of the detrusor muscle (DM) in a tissue from a patient with pT1 bladder cancer (BCa). For a study, researchers sought to find out if getting enough DM depends on the skill of the surgeon, if it can be used as a measure of the quality of the surgery, and if the thickness of the DM is linked to how well the patient does after en bloc resection for bladder tumors (ERBT). They looked at the records of 106 patients with pT1 high-grade BCa who had ERBT at different hospitals. Only one doctor looked at all the samples and used a millimeter to check for DM and record its presence or lack. The measure that showed how well the resection worked was early recurrence, described as pathologically proven BCa on repeat excision or tumor return at the first follow-up cystoscopy (within 3 months).

Of 106 cases, 99 (93% of them) had DM, and the average width of the DM was 1.8 mm. A bigger tumor (>30 mm) was linked to better DM sampling (>1.8 mm) (odds ratio [OR]: 6.10, 95% confidence intervals [CIs]: 2.08–17.9, P = 0.001), but the experience of the surgeon wasn’t. DM prevalence and DM width were not linked to early recurrence. However, a positive surgery margin strongly indicated early recurrence (OR: 3.38, 95% CI: 1.12–10.2, P=0.031). A longer urethral puncture was linked to taking too many DM samples (>2.1 mm) (OR: 28.8, 95% CI: 3.36–248, P = 0.002).

In ERBT, the therapist’s skill doesn’t matter to get DM. The quality of the resection depends on the state of the surgery margins, not the amount of DM. Getting too much DM leads to bad things happening and extra medical care that is optional.

Source: sciencedirect.com/science/article/abs/pii/S1078143923002636