Abstract
BackgroundTransurethral resection (TUR) is the standard operation used for non-muscle invasive bladder cancer (NMIBC). Although most solid tumors are principally removed via single block resection without incising the mass, disruption of the lesion is unavoidable in traditional TUR. Furthermore, pathological diagnosis is often difficult due to heat-related denaturation of tissues in TUR. Although transurethral en-bloc resection is useful for judging tumor invasion, it is associated with a prolonged operative duration. We attempted to show the safety and usefulness of combined endoscopic mucosal resection (EMR) and en-bloc resection in NMIBC patients.MethodsWe investigated 39 patients with clinical NMIBC who were treated using our original EMR + en-bloc resection technique, which involved removal of the tumor mass that protruded from the mucosa, using a polypectomy snare similar to that used for EMR. The residual lesion was removed using en-bloc resection. The operative period, duration of hospitalization, and recurrence rates were compared with those of conventional TUR (n = 31).ResultsThe mean (standard deviation, range) time interval for EMR and total operative duration were 1.6 (1.1, 1–5) min and 18.3 (10.5, 3–48) min, respectively. The total operative duration was comparable to that of TUR (17.3 min, p = 0.691). The mean duration of catheterization in the EMR + en-bloc resection group (4.2 days) was also similar to that in the TUR group (3.7 days; p = 0.285). No severe complications were observed with EMR + en-bloc resection. The pathologists were able to determine tumor invasiveness with considerable certainty in all specimens obtained via the EMR + en-bloc procedure than via TUR, and the difference in the ease of diagnosis was statistically significant (p = 0.016). Recurrence rates were comparable (p = 0.662) between the EMR + en-bloc (15.4%) and TUR groups (19.4%).ConclusionsOur results demonstrated that the EMR + en-bloc resection technique is feasible, safe, and useful for treating patients with NMIBC. Furthermore, this technique helps provide a more accurate pathological diagnosis.
Highlights
Transurethral resection (TUR) is the standard operation used for non-muscle invasive bladder cancer (NMIBC)
While conventional TUR is performed as a standard procedure for the removal of all tumours diagnosed as NMIBC, en-bloc resection is utilized in patients with ≤3 lesions, each with diameter < 1.5 cm
This study is not a randomized clinical trial, we found no significant differences in the clinicopathological characteristics between the participants included in the endoscopic mucosal resection (EMR) + en-bloc and the TUR groups (Table 1)
Summary
Transurethral resection (TUR) is the standard operation used for non-muscle invasive bladder cancer (NMIBC). Transurethral en-bloc resection is useful for judging tumor invasion, it is associated with a prolonged operative duration. Transurethral resection (TUR) remains the gold standard for the treatment of NMIBC. The choice of a radical resection procedure is an important determinant of the outcome in patients with NMIBC. Reaching an accurate diagnosis, especially in the pathologic stage (pT), is important to choose appropriate treatment strategies in these patients. An accurate histopathological diagnosis leads to reduction of overall treatment costs, because an unnecessary second TUR procedure or adjuvant intra-vesical therapy is avoided. The goal of TUR in early BC is to completely excise visible masses and obtain tissues for an accurate pathological diagnosis of the tumor
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