Surgical checklist impact on recurrence‐free survival of patients with non‐muscle‐invasive bladder cancer undergoing transurethral resection of bladder tumour

• DOI: 10.1111/bju.14557
• Publication Date: 2018-09-24T17:12:58Z
• Authors: Rodrigo Suarez‐Ib...; Francesco Soria; Mohammad Abufaraj; David D'Andrea; Mirko Preto; Kilian M. Gust; Alberto Briganti; Shahrokh F. Shariat; Paolo Gontero
• Keywords: surgical checklist; Male; transurethral resection of bladder tumour; Urologists; Middle Aged; bladder cancer; NMIBC; recurrence-free survival; surgical checklist; transurethral resection of bladder tumour; Urology; Disease-Free Survival; Checklist; 3. Good health; Treatment Outcome; Urinary Bladder Neoplasms; Health Care Surveys; Practice Guidelines as Topic; bladder cancer; Humans; Urologic Surgical Procedures; Female; Neoplasm Invasiveness; recurrence-free survival; Neoplasm Recurrence, Local; Practice Patterns, Physicians'; NMIBC; Aged

ObjectivesTo evaluate the impact of an eight‐item surgical checklist (SC) on the recurrence‐free survival (RFS) of patients with non‐muscle‐invasive bladder cancer (NMIBC) undergoing transurethral resection of bladder tumour (TURBT).Patients and MethodsA group of urologists at two tertiary referral centres, with expertise in bladder cancer, identified eight critical items that should be performed in every high‐quality TURBT. An eight‐item SC was prospectively implemented into clinical practice and the operative reports of TURBTs performed before and after implementation were reviewed. Results from both institutions were combined to estimate the impact of introducing the SC on oncological outcomes. Multivariable logistic and Cox hazards regression analyses were performed to evaluate the impact of the SC on the presence of detrusor muscle in the TURBT specimen and on RFS, respectively.ResultsThe operative reports of 266 TURBTs performed after the SC implementation were reviewed and compared to those of 281 TURBTs performed prior to the SC introduction. The SC was independently associated with a significant improvement in RFS (P = 0.02). However, the introduction of the SC was not significantly associated with the presence of detrusor muscle in the surgical specimen (P = 0.4).ConclusionThe use of an eight‐item SC during TURBT in clinical practice increases the quality of operative reports thereby potentially improving individualised risk‐stratification and care resulting in lower disease recurrence rates. Therefore, the introduction of a SC can be recommended to enhance oncological outcomes by improving surgical standardisation and operative reporting.