Evaluation of the use of postoperative single-shot instillation chemotherapy  after TURBT and reasons for not administering it

Overview

Aim of Study: Mitomycin C (MMC) instillation after transurethral resection of bladder tumour (TURBT) reduces the risk of bladder cancer recur rence. The aim of this study was to evaluate the use of single postoperative chemotherapy instillation after TURBT at our institution and the reasons for not administering it. Patients and Methods: A retrospective evalu ation of a cohort of patients undergoing TURBT from 2016–2022. The total number of TURBTs and the total number of single‑shot MMC instillations (SS‑MMC) were evaluated. In particular, the group of patients with no obvious reason for not admin istering MMC was evaluated. Furthermore, the reasons for not administering MMC were evaluated. Results: During the follow‑up period, 735 TURBTs were performed in 538 men and 197 wom en (mean age 71 years, median 75 years) and 211 SS‑MMCs (28.7%) were administered. After exclud ing patients with macroscopically evident residual tumor and palliative endoresection (n = 102) and patients with endoresection for reasons other than bladder cancer (n = 24), 609 TURBTs were per formed when MMCs could be instillated. In this group, the representation of SS‑MMC was 34.7%. The most common identified reason for not administering SS‑MMC (n = 398) was hematuria (n = 83, 20.9%), bladder wall perforation (n = 66, 16.6%), and allergy (n = 4, 1%). In 245 patients (61.6%), the reason for not administering could not be traced. The reduction in the number of applications in 2019 and 2020 was due to the lack of availability of MMC and the COVID‑19 epidemic. Conclusion: Data on the actual practice of single instillation of chemotherapeutic agents af ter TURBT are scarce and suggest that its use is rather low. According to our data, it is administered in approximately one third of potentially suitable patients. Interpretation of the results is hampered by the lack of information on the reasons for not administering MMC in retrospective analysis of the documentation.

Keywords:

Bladder cancer, postoperative intravesical chemotherapy, single shot mitomycin C, transurethral bladder resection.