Can immediate second resection be an alternative to standardized second transurethral resection of bladder tumors?

Abstract

This study analyzed the impact of an immediate second transurethral resection of bladder tumor (TURBT) protocol on residual tumor status at the initial TURBT session and the recurrence rate in the primary resection area. We prospectively evaluated and randomized 47 consecutive patients who underwent TURBT sessions for bladder cancer. In accordance with the inclusion criteria, of the 47 consecutive patients, 19 (Group I) underwent immediate second resection of the tumor bed after complete TUR and 28 (Group II) did not. After standard TURBT, Group I underwent a second cystoscopy and resection of the bed of the tumor or an ignored tumor, which was performed by a different urologist. After 4-6 weeks, delayed second TURB was performed, and all pathological results were evaluated. Tumors were detected in two patients during the immediate second resection. Of these, one was a misdiagnosed tumor, whereas the other was diagnosed at the bed of the tumor by pathological examination. Tumors were detected in nine patients at the delayed second TURB, of which only one was part of Group I, while the others were part of Group II (p = 0.04). The results of this study demonstrated that residual tumors may remain after initial TURB, either in the tumor bed or in a different location within the bladder. Although this was a pilot study enrolling only a small number of patients, our initial results supported the assertion that immediate second resection can be an alternative to standard second TURBT.

Endoscopic balloon cryoablation plus transurethral resection for bladder cancer: A phase 2, multicenter, randomized, controlled trial

“…(B) The short-term progression-free survival of TUR plus EBCA was better (HR, 0.19; 95% CI, 0.05-0.65; log-rank p = .003) it was reported that residual tumor cells covered by extracellular matrix could be resistant to adjuvant chemotherapy and BCG. 22 Therefore, we believe that patients with high-risk NMIBC will still benefit by LC of the disease from SI, although it might be dampened by adjuvant therapies. A similar result showed that high-risk NMIBC patients might get few benefits from SI.…”

“…Upstaging occurred in 0% to 8% (Ta to ≥T1) and 0% to 32% (T1 to ≥T2) of patients. In one RCT, an immediate ReTUR was performed by another urologist and the residual tumor rate was 10.5% 22 . To improve the efficacy of TUR, attempts have been made to improve surgical techniques and adjuvant therapy.…”

“…In our study, SI was given as a control intervention, under the following considerations: (1) it has been one of the most common adjuvant therapies in preventing NMIBC recurrence inside urinary bladder in China in 2016; (2) most of the patients were enrolled based on CT and/or cystoscopy. Because of a lack of accurate pathological evaluation, it was difficult for risk stratification before diagnostic TUR; (3) it was reported that residual tumor cells covered by extracellular matrix could be resistant to adjuvant chemotherapy and BCG 22 . Therefore, we believe that patients with high‐risk NMIBC will still benefit by LC of the disease from SI, although it might be dampened by adjuvant therapies.…”

“…In one RCT, an immediate ReTUR was performed by another urologist and the residual tumor rate was 10.5%. 22 To improve the efficacy of TUR, attempts have been made to improve surgical techniques and adjuvant therapy. The recurrence rate at 4 **This p value was calculated using Fisher exact test.…”