Vigilancia y manejo en consulta de los tumores de vejiga Ta de bajo grado

Abstract

ObjectivePatients with low-grade (LG), grade 1-2, Ta bladder cancer (BC) will frequently have a “recurrence”. However, they rarely progress in stage. Although current guidelines mention surveillance and office management for these new or recurrent tumors, transurethral resection is the most common treatment. The purpose of this study is to determine if surveillance and/or office cautery is safe. Materials and methodsThis study was conducted as a retrospective case series analysis of 45 patients who had recurrent LG Ta appearing BC and were managed primarily with surveillance and/or office cautery. Patients with carcinoma in-situ were excluded. The primary outcome was stage progression. ResultsMedian follow-up was 62 months. Forty-one (91%) patients did not progress in stage. Three patients recurred with high grade (HG) T1 BC; one is receiving systemic immunotherapy. One patient developed HG T2 BC and was treated with a bladder preservation protocol. Forty (89%) patients underwent office cauterization. Eleven received BCG and 26 received post-cautery intravesical chemotherapy. Five (11%) patients developed HG BC during follow-up. No patients died. None of the 17 (38%) Hispanic patients had progression. ConclusionsActive surveillance and/or office cautery for patients with small recurrent LG Ta bladder tumors is safe, reduces cost and improves quality of life by avoiding transurethral resections.