PD11-04 TRANSURETHRAL ENDOSCOPIC SUBMUCOSAL EN BLOT DISSECTION FOR NON-MUSCLE INVASIVE BLADDER TUMOR: A PROSPECTIVE COMPARISON STUDY OF HYBRIDKNIFE ASSISTED VERSUS CONVENTIONAL DISSECTION TECHNIQUE

Abstract

INTRODUCTION AND OBJECTIVES: Endoscopic submucosal dissection (ESD), an emerging new technology, had been reported to safely, effectively and en blot dissection method for gastrointestinal epithelial tumors treatment, which maybe a better en blot desection approach for NMIBC treatment. The present study is to compare the efficacy and safety of bladder tumor-endoscopic submucosal dissection (BT-ESD) and conventional transurethral resection of bladder cancer (TURBT) in patients with non-muscle invasive bladder tumor (NMIBC). METHODS: A prospective trial was carried out in Shaanxi Provincial People’s Hospital (Shaanxi, China), 75 patients eligible suspicious NMIBC, between November 2013 and Oct 2014, were constructively enrolled in and randomized to use of either the BT-ESD (ESD Group, 38 cases) or the TURBT treatment (TURBT group, 37 cases). The operation time, blood loss, postoperative bladder irrigation time, catheter indwelling time, hospital stay, complications and 1-year tumor recurrence rate were compared between 2 groups. RESULTS: A total of 75 patients with comparable characteristics between groups were included. The ESD group showed increased average operation time than TURBT group (30.2 9.2 min v.s 15.08 6.1 min, p< 0.05), respectively, no significant difference were found in the smaller tumor (0-2cm). The postoperative bladder irrigation time, catheter indwelling time and hospital stay in BT-ESD group were significantly shorter than TURBT group (8.3 2.8h, 2.3 0.9d and 3.0 1.3d for ESD group;16.7 3.6h, 4.8 1.3d and 6.5 1.8d for TURBT group). In addition, the BT-ESD group showed decreased overall incidence of complications (7.9% v.s 18.9%, p<0.05) and 1-year tumor recurrence rate (5.3% v.s 21.6%, p < 0.05). CONCLUSIONS: We conclude that BT-ESD as a novel approach used for NMIBT appears to be a feasibly safe and applicable. Compared with conventional TURBT, BT-ESD applies an en bloc resection technique following the principles of oncologic surgery by using HybirdHnife to facilitate histopathologic assessment more accurate and reach a R0 resection. This is much critical for planning strategy of intravesical instillation, assessing prognosis and determining the protocol of follow-up, with respective potential advantages in decreasing rates of tumor recurrence and progression, and reducing socioeconomic costs. Clearly, BT-ESD appears to benefit the patients and is worth popularizing application in clinic.