RESECT: A Randomised Controlled Trial of Audit and Feedback in Non-muscle-invasive Bladder Cancer Surgery.
Abstract
BACKGROUND AND OBJECTIVE: We aimed to determine whether audit, feedback, and education improves surgical performance after transurethral resection of bladder tumour surgery for non-muscle-invasive bladder cancer and as a secondary aim if it reduced recurrence rates.
METHODS: This cluster randomised controlled trial compared audit and feedback plus peer comparison and education, with audit alone for four coprimary outcomes: (1) Single-instillation chemotherapy, (2) detrusor muscle sampling, (3) documentation of tumour features, and (4) resection completeness. Early recurrence was a secondary outcome.
KEY FINDINGS AND LIMITATIONS: A total of 100 sites were randomised to intervention and 101 to control. In total, 14 915 patients were included. Intervention sites significantly improved documentation of tumour features (adjusted mean difference [95% confidence interval {CI}]: 6.0 [1.8, 10], p = 0.005) and of resection completeness (adjusted mean difference [95% CI]: 5.5 [1.5, 9.5], p = 0.007). There was no statistically significant difference in chemotherapy use (adjusted mean difference [95% CI]: 0.3 [-4.7, 5.3], p = 0.9) or detrusor muscle sampling (adjusted mean difference [95% CI]: 2.6 [-1.3, 6.4], p = 0.2). There was no statistically significant difference in early recurrence rate between arms (adjusted odds ratio [95% CI]: 1.02 [0.8, 1.4], p = 0.9); however, in the control arm, the early recurrence rate reduced compared with baseline (adjusted odds ratio [95% CI]: 0.7 [0.6, 0.9]).
CONCLUSIONS AND CLINICAL IMPLICATIONS: Audit and feedback with education improved the documentation of important surgical findings that influence clinical management, but not the performance of detrusor muscle sampling, adjuvant chemotherapy use, or early recurrence rates. Improvements observed in the control arm may explain a lack of effect of the intervention in some outcomes.
Author
Gallagher, Kevin
MacLennan, Steven
Bhatt, Nikita
Clement, Keiran
Zimmermann, Eleanor
Khadhouri, Sinan
Kulkarni, Meghana
Gaba MPhil, Fortis
Anbarasan, Thineskrishna
Asif, Aqua
Light, Alexander
Ng, Alexander
Chan, Vinson Wai-Shun
Nathan, Arjun
Cooper, David
Aucott, Lorna
Sakthivel, Deerush
Akand, Murat
Piazza, Pietro
Marcq, Gautier
O'Brien, Tim
Nielsen, Matthew
Giudice, Francesco Del
Simpson, Keith
Orecchia, Luca
Teixeira, Bernardo
Dawam, Daben
Geisenhoff, Alexander
Hill, George
Fukuokaya, Wataru
Hidalgo, Beatriz Gutiérrez
El-Hajj, Albert
Elgamal, Mostafa
Fanshawe, Jack
Wang, Betty
Lee, Taeweon
Manecksha, Rustom
McCann, Conor
Rivas, Juan Gomez
Arda, Ersan
Elhadi, Muhammed
Rossi, Sabrina
Teoh, Jeremy Yuen-Chun
Mariappan, Paramananthan
Kasivisvanathan, Veeru
MacLennan, Steven
Bhatt, Nikita
Clement, Keiran
Zimmermann, Eleanor
Khadhouri, Sinan
Kulkarni, Meghana
Gaba MPhil, Fortis
Anbarasan, Thineskrishna
Asif, Aqua
Light, Alexander
Ng, Alexander
Chan, Vinson Wai-Shun
Nathan, Arjun
Cooper, David
Aucott, Lorna
Sakthivel, Deerush
Akand, Murat
Piazza, Pietro
Marcq, Gautier
O'Brien, Tim
Nielsen, Matthew
Giudice, Francesco Del
Simpson, Keith
Orecchia, Luca
Teixeira, Bernardo
Dawam, Daben
Geisenhoff, Alexander
Hill, George
Fukuokaya, Wataru
Hidalgo, Beatriz Gutiérrez
El-Hajj, Albert
Elgamal, Mostafa
Fanshawe, Jack
Wang, Betty
Lee, Taeweon
Manecksha, Rustom
McCann, Conor
Rivas, Juan Gomez
Arda, Ersan
Elhadi, Muhammed
Rossi, Sabrina
Teoh, Jeremy Yuen-Chun
Mariappan, Paramananthan
Kasivisvanathan, Veeru
Date
2025-12-10
Type
Article
Subject
Urology
Collections
Citation
Eur Urol . 2025 Dec 10:S0302-2838(25)04736-0.
Journal / Source Title
European urology
DOI
10.1016/j.eururo.2025.09.4174
PMID
41444076
Publisher
Elsevier
Publisher’s URL
https://www.sciencedirect.com/science/article/pii/S0302283825047360?via%3Dihub