The Learning Curve for Transurethral Resection of Bladder Tumour: How Many is Enough to be Independent, Safe and Effective Surgeon?

OBJECTIVE: Transurethral resection of the bladder tumour (TURBT) is one the most common urological procedures. It is also one the fundamental surgeries performed by residents. The learning curve (LC) for TUR has never been analysed. The aim of the study was to analyse the learning curve of TURBT in a residency setting. DESIGN, SETTING AND PARTICIPANTS: This retrospective multicentre analysis of prospectively maintained databases enrolled 993 consecutive TURBTs performed by 10 urology residents in 3 academic institutions. Study end-points were as follows: the absence of muscularis propria in a specimen, any intra- or postoperative surgical complication and 3-month recurrence-free survival. RESULTS: With increasing experience, residents operated more complex cases defined by higher rate of large, multifocal or high-risk tumours. In the same time, surgery time, postoperative catheterization time and hospital stay became shorter. An improvement has been noticed regarding the muscularis propria sampling and 3-month recurrence-free survival, but not regarding the risk of surgical complications. Evident improvement in study end-points was noticed after 101 operations; surgeons achieved the best clinical outcomes after performing 170 procedures, whereas the poorest results for the first 45 operations. CONCLUSIONS: TURBT has a flat LC with 100 cases being the absolute minimum for a resident in training to achieve acceptable oncological and surgical outcomes.

Surgical treatment for renal masses in the elderly: analysis of oncological, surgical and functional outcomes.

PURPOSE: Radical treatment in elderly patients with renal tumor remains debatable due to uncertainties regarding the risk of surgical complications, risk of end-stage renal disease (ESRD) and survival benefit. The aim of the study was to assess outcomes of radical treatment for renal cancer in elderly patients. MATERIALS AND METHODS: This retrospective analysis enrolled 507 consecutive patients treated with partial or radical nephrectomy due to renal mass. Patients with upfront metastatic disease (n=46) and patients lost to follow-up (n=110) were excluded from the analysis. Surgical, functional (screen for ESRD development) and survival outcomes were analyzed in patients aged >75 years in comparison to younger individuals. RESULTS: The analyzed group included 55 elderly patients and 296 younger controls. Within the cohort a total of 148 and 203 patients underwent radical and partial nephrectomies respectively. The rate of surgical complications, including grade >3 Clavien- Dindo complications, did not differ between groups (3.6% vs. 4.4%, p=0.63). Median length of hospital stay was equal in both groups (7 days). During a follow-up (median 51.9 months, no difference between groups), ESRD occurred in 3.4% of controls and was not reported in elderly group (p=0.37). Younger patients demonstrated a statistically significant advantage in both overall survival and cancer-specific survival over elderly patients (OS 94.6% vs. 87% p=0.036, CSS 97.3% vs. 89.1% p=0.0008). CONCLUSIONS: Surgical treatment in elderly patients with renal tumor is as safe as in younger individuals and does not increase the risk of ESRD. However, cancer specific survival among these patients remains shorter than in younger patients.