EN BLOC RESECTION OF NON MUSCLE INVASIVE BLADDER CANCER: EXPERIENCE IN SANT’ANNA HOSPITAL – COMO
The goal of traditional trans-urethral resection of bladder tumors (TURBT) is to remove all visible cancers and obtain tissue for pathological diagnosis, with minimal morbidity to the patient, even if the tumor is removed in piecemeal. Additionally, detrusor muscle (DM) is absent in up to 50% of cases. Moreover, residual disease is diagnosed in the final pathology in up to 76% of cases of the restaging TURBT. Recently, the urologists' approach to the management of superficial bladder cancer has been evolving and the basic principle of oncologic surgery of removing the entire tumor “en bloc” by dissecting through normal tissue to prevent the scatter of malignant cells and positive surgical margins is becoming more and more important.
The aim of the present study is the description of both “en-bloc” technique in Our Centre and the medium-term results of our single-center experience with “en-bloc resection of bladder tumors” (ERBT) in a selected group of patients.
Materials and Methods
We retrospectively analyzed the story of 24 patients consecutively underwent to ERBT. A single expert urologist executed the procedure using a mono-polar or bipolar Storz 24 Ch resector.
The surgeon executed a “U-shaped” incision anteriorly to the lesion, with a mucosal margin of 3 mm, including macroscopically sane tissue. Thus, the incision was conducted in retrograde way going under the lesion, until obtaining a complete detachment from the bladder wall. Laterally, the incision included the margin of sane mucosa. The depth of the incision included the muscle layer.
A trans-urethral catheter was positioned after the operation; the same was removed after 48 hours.
We also compared our experience with data literature, searching for the key words: “En bloc resection”, “Trans-urethral resection” and “Non Muscle Invasive Bladder Cancer”.
We enrolled 24 patients (21 males and 3 females); all showed a Non Muscle Invasive Bladder Cancer (NMIBC) urothelial carcinoma; among these, 3 had High grade NMIBC, 1 Carcinoma in Situ, 1 PULMP, and 20 showed low grade NMIBC at the definitive pathology. All the ERBT samples showed the presence of DM. The mean age at diagnosis was 69 years (range 53-87), presenting with a mean tumor diameter of 8± 3 mm and a median number of resected tumors per patients of 1 (range 1-3). In 7 case the procedure (first in all patients) was associated with early instillation of epirubicin within 30 minutes after TUR. In 6 cases the ERBT was not the first TUR in the history of the patients. The mean follow-up was 25 months (range 7-60 months) and there was a recurrence rate in 7/24 patients, with low grade final pathology. The main limitation of the study consists in the absence of a control group.
Our findings confirmed the feasibility and safety of en bloc resection of bladder tumor, with a recurrence-free survival of 71%.
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