TURBT v. parotidectomy

  • 69-year-old lady for TURBT. 
  • Incidental finding of large bladder tumour on surveillance imaging.  No haematuria/obstructive symptoms


  • Non-small cell lung cancer – Stage IV with Brain metastases, complete response to palliative radiotherapy
  • Right parapharyngeal mass on previous surveillance PET.
  • Asymptomatic. Biopsy showed atypia but ENT surgeons concerned about change in size and shape of mass. 
  • Listed for parotidectomy (cat 2)


  • COPD, moderate disease FEV1/FVC = 0.6 (79%). 50 pack year smoking history
  • Significant deconditioning; 3.9 METS on DASI. Walks 20-30m with stick or 4WW
  • Clinical depression with suicidal ideation. Rarely leaves home
  • Iron deficiency
  • Reviewed at perioperative clinic 6/12 ago
  • Referred for prehab, very motivated family but on hold currently due to COVID
  • No change since last clinic review 


Which Surgery Should Proceed First?

  • Consensus that TURBT should occur
  • Large bladder tumour with potential for obstructive symptoms
  • Urologist is aware of patient limitations and prepared for a debulking procedure if surgery is technically difficult
  • ENT procedure needs to be done but pharyngeal mass not malignant and remains asymptomatic
  • Imperative to update ENT surgeons of delay of at least 6 weeks

Optimisation options

  • Clinical issues – deconditioning and Fe-deficiency both being addressed
  • Depression is severely impacting functional capacity
  • Prehabilitation – psychological as well as physical benefits; social aspect advantageous in isolated people
  • GP manages depressive symptoms, on multiple pharmacotherapies with little effect
  • Letter to GP in May regarding possibility of specialist input but nil yet.
  • Psychiatry and psychology services currently very difficult to obtain


  • Fe-infusion and proceed to TURBT
  • GP letter regarding psychiatrist and/or psychologist for optimisation of mental health symptoms
  • Prehab can occur pre-ENT surgery
  • Discussion with family around Advanced Care Planning