COMPARISON OF RECURRENCE RATE BETWEEN “EN BLOC” RESECTION OF BLADDER TUMOUR AND CONVENTIONAL TECHNIQUE FOR NON-MUSCLE INVASIVE BLADDER CANCER
AbstractBackground: Conventional transurethral resection of urinary bladder tumour (TURBT) using a wire loop diathermy violates the basic principle of oncological surgery, i.e. dissection through normal tissue. However, in the en bloc technique, the tumour is removed as a single specimen. We compared the quality of specimen and recurrence rate at three months (first check cystoscopy) in both the en bloc and conventional resection techniques. Methods: The subject accrual was done from June 1st, 2017 till June 30th, 2019 at a tertiary care hospital. Patients with newly diagnosed bladder tumour, solitary or multiple ≤ 3cm were included in the study. Patients with carcinoma in situ, prior TURBT, or muscle-invasive bladder cancer were excluded. Eighty-two patients were available for final analysis, 41 in each group. Results: Mean age, gender ratio, tumour features (grade, stage, median number, and size) were comparable in the two groups. Median Operative time [interquartile range- (IQR)] was 30 (25 – 39.5) minutes in the en bloc group as compared to 45 (33 – 63.5) minutes in the conventional group (p < 0.001). The detrusor muscle was seen at the base of the primary tumour in all 41 (100%) en bloc cases as compared to 23 (56 %) cases in the conventional group (p <0.001). Overall recurrence at the first surveillance cystoscopy was 17%, with an insignificant difference between the groups. Recurrence at primary site was 19.5% in conventional TURBT compared to en bloc resection (n = 1, 2.4%), (p = 0.013). Conclusion: En bloc resection decreases the recurrence rate at the primary site. En bloc TURBT is a safe technique, providing high-quality specimens for histopathological evaluation and reducing the need for the second TURBT.Keywords: En bloc TURBT; conventional TURBT; non-muscle-invasive bladder cancer; recurrence rate; detrusor muscle
Sureka SK, Agarwal V, Agnihotri S, Kapoor R, Srivastava A, Mandhani A. Is en-bloc transurethral resection of bladder tumor for non-muscle invasive bladder carcinoma better than conventional technique in terms of recurrence and progression?: A prospective study. Indian J Urol 2014;30(2):144–9.
Colombel M, Soloway M, Akaza H, Böhle A, Palou J, Buckley R, et al. Epidemiology, staging, grading, and risk stratification of bladder cancer. Eur Urol Suppl 2008;7(10):618–26.
Farhan M, Muhammad NS, Ahmed J, Ather H. Frequency and predictors of recurrence of bladder tumour on first check cystoscopy-a tertiary care hospital experience. J Pak Med Assoc 2016;66(10):S125–130.
Donat SM. Evaluation and follow-up strategies for superficial bladder cancer. Urol Clin North Am 2003;30(4):765–76.
Maruniak N, Takezawa K, Murphy W. Accurate pathological staging of urothelial neoplasms requires better cystoscopic sampling. J Urol 2002;167(6):2404–7.
Cheng YY, Sun Y, Li J, Liang L, Zou TJ, Qu WX, et al. Transurethral endoscopic submucosal en bloc dissection for nonmuscle invasive bladder cancer: A comparison study of HybridKnife-assisted versus conventional dissection technique. J Can Res Ther 2018;14(7):1606–12.
Upadhyay R, Kapoor R, Srivastava A, Krishnani N, Mandhani A. Does En bloc transurethral resection of bladder tumor give a better yield in terms of presence of detrusor muscle in the biopsy specimen? Indian J Urol 2012;28(3):275–9.
Wolters M, Kramer MW, Becker JU, Christgen M, Nagele U, Imkamp F, et al. Tm: YAG laser en bloc mucosectomy for accurate staging of primary bladder cancer: early experience. World J Urol 2011;29(4):429–32.
Antoni S, Ferlay J, Soerjomataram I, Znaor A, Jemal A, Bray F. Bladder cancer incidence and mortality: A global overview and recent trends. Eur Urol 2017;71(1):96–108.
Bhurgri Y, Bhurgri A, Hassan SH, Zaidi S, RahimA, Sankaranarayanan R, et al. Cancer incidence in Karachi, Pakistan: first results from Karachi cancer registry. Int J Cancer 2000;85(3):325–9.
Herr H, Donat S. A re-staging transurethral resection predicts early progression of superficial bladder cancer. BJU Int 2006;97(6):1194–8.
Herr HW, Donat MS. Quality control in transurethral resection of bladder tumors. BJU Int 2008;102(9 Pt B):1242–6.
Chen J, Zhao Y, Wang S, Jin X, Sun P, Zhang L, et al. Green‐light laser en bloc resection for primary non‐muscle‐invasive bladder tumor versus transurethral electroresection: a prospective, nonrandomized two‐center trial with 36‐month follow‐up. Lasers Surg Med 2016;48(9):859–65.
Dutta SC, Smith JA Jr, Shappell SB, Coffey CS, Chang SS, Cookson MS. Clinical under staging of high-risk nonmuscle invasive urothelial carcinoma treated with radical cystectomy. J Urol 2001;166(2):490–3.
Hurle R, Lazzeri M, Colombo P, Buffi N, Morenghi E, Peschechera R, et al. “En bloc” resection of nonmuscle invasive bladder cancer: a prospective single-center study. Urology 2016;90:126–30.