Retrograde en bloc resection for non-muscle invasive bladder tumor can reduce the risk of seeding cancer cells into the peripheral circulation

Haichao Huang,Metages Gashaw Ahmed,Chaoyong Yang,Zhun Wu,Wei Li,Kaiyan Zhang,Jinchun Xing,Tao Wang,Lin Zhu,Xuegang Wang

doi:10.1186/s12957-020-1808-0

Abstract

ObjectiveTo ascertain whether en bloc resection could reduce the risk of seeding cancer cells into the circulation during the resection of non-muscle invasive bladder cancer (NMIBC).MethodsPatients with primary NMIBC were enrolled in this prospective study from October 2017 to May 2018. Patients were allocated to receive conventional transurethral resection of the bladder (TURB) or retrograde en bloc resection technique of the bladder tumor (RERBT). Blood samples (1 ml) for circulating tumor cell (CTC) enumeration were drawn from the peripheral vein prior to resection (PV1), immediately after resection of the tumor base (PV2), and at 12 h after resection (PV3). Intra-group comparisons of the changes in the number of CTCs identified among the PV1, PV2, and PV3 blood samples were performed in each group.ResultsA total of 21 patients (12 in the RERBT group and 9 in the TURB group) were recruited. For patients receiving TURB, the level of CTCs identified in PV3 was significantly higher than that in PV1 (p = 0.047). However, there was no significant difference in CTC counts before and after resection in the RERBT group.ConclusionRERBT did not increase the number of tumor cells in the bloodstream.

Highlights

Bladder cancer is the second most common type of urological cancer after prostate cancer [1], and transurethral resection of the bladder (TURB) is the standard in the management of non-muscle invasive bladder cancer (NMIBC) [2]
Micro abstract The aim of this study was to ascertain whether en bloc resection could reduce the risk of seeding cancer cells into the circulation during the resection of non-muscle invasive bladder cancer (NMIBC)
en bloc resection of the bladder tumor (ERBT) is an alternative surgical management for endoscopic treatment of NMIBC that may reduce the risk of cell seeding during resection

Summary

Introduction

Bladder cancer is the second most common type of urological cancer after prostate cancer [1], and transurethral resection of the bladder (TURB) is the standard in the management of non-muscle invasive bladder cancer (NMIBC) [2]. During the process of TURB, a piece-by-piece resection to the muscle layer is performed and the pressure within the bladder exceeds the venous pressure. Increasing evidence shows that TURB may contribute to the increase in circulating tumor cell (CTC) count in patients with urothelial carcinoma of the bladder (UCB), and en bloc resection of the tumor may be a new approach to address this issue [3, 4]. Huang et al World Journal of Surgical Oncology (2020) 18:33 cells into the circulation during resection. To test this hypothesis, we introduced a novel retrograde en bloc resection of the bladder tumor (RERBT) technique, which has been reported in our previous study [5], and we measured the CTC counts before and after the resection.

Methods

Results

Discussion

Conclusion