Clinical Value of Transurethral Second Resection of Bladder Tumor: Systematic Review

OBJECTIVE To systematically review prospective trials aimed at the role of restaging transurethral resection (reTUR) to define the group of patients with bladder cancer who would benefit. MATERIALS AND METHODS A systematic review of the literature in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines was conducted. RESULTS Of 120 trials, 7 met the inclusion criteria. Most studied populations were high-risk non-muscle-invasive bladder cancer patients. Low-risk cancers as well as muscle-invasive disease were analyzed in only 1 trial. Consistently through the publications, reTUR improved staging with the rates of muscle-invasive disease mounting to 17.6% when primary resection was deemed to be complete. Although all trials corroborated staging role of reTUR, only 4 provided recurrence and progression outcomes, the first being significantly lower in the group of second early resection. In 2 studies with the longest follow-up and the greatest number of patients with high-risk non -muscle-invasive bladder cancer, progression rates were found to be improved. In one trial, reTUR was associated with better response to bacille Calmette-Guerin. CONCLUSION The data convincingly suggest that early second resection improves staging and reduces the recurrence as well as progression rates of high-risk bladder tumors. reTUR brings benefit to those subjected to bacille Calmette-Guerin. However, additional surgery would not modify treatment plan in those with low-risk disease. (C) 2014 Elsevier Inc.