Comparison of the safety and efficacy of the new method of en-bloc and conventional monopolar transurethral resection in the management of primary non-muscle-invasive bladder cancer

Abstract

Objective: to comparе the safety and efficacy of the new method of en-bloc transurethral resection (TUR) and conventional TUR in management of primary non-muscle-invasive bladder cancer, and investigate long-term effects on tumour recurrence and progression.Materials and methods. A total of 914 patients with primary non-muscle-invasive bladder cancer were treated using TUR of bladder at the Minsk City Clinical Oncologic Dispensary in 2005 to 2016. For final analysis the data was underwent many-stage random sampling. Randomization was stratified according to sex and age, category T, tumour grade, EORTC risk groups. In total, 273 patients were selected: 136 in the new method of en-bloc TUR group (a study group) and 137 in the conventional TUR group (a control group). The new method of en-bloc TUR is based on using impulses of high-frequency current applied to the active electrode of the resectoscope. The impulse sequence and individual impulse duration within the interval from 0.1 to 1 second are controlled in the course of the operation. Five-year follow-up data of operative management were analyzed.Results. In event of the new method of en-bloc TUR there were no perioperative complications and no cases of conversion to conventional TUR. Postoperative complications were less frequently observed in the new method group compared with conventional TUR group. There were significant differences with major priority to the new method of en-bloc TUR in median time to recurrence (р = 0.032) and progression (р = 0.001), 5-year survival to recurrence (р = 0.0001) and progression (р = 0.001), 5-year cancer-specific survival (р = 0.033) and overall survival (р = 0.045) of patients.Conclusion. The new method of en-bloc TUR of non-muscle-invasive bladder cancer was more effective than conventional TUR in reducing rates of intraand postoperative complications, and at the same time was applicable in all clinical cases, regardless of the tumor location in the bladder lumen, its size, vascularization, and growth pattern. The new method of en-bloc TUR also significantly improved the long-term cancer treatment results in patients with primary non-muscle-invasive bladder cancer.

En Bloc Resection for Bladder Tumors: An Updated Systematic Review and Meta-Analysis of Its Differential Effect on Safety, Recurrence and Histopathology

“…11,12,46 Surgical margin diagnostic rate was 63% to 95% in our included studies. 11,29,51 In our previous study, the vertical margin could be diagnosed almost 100% of cases, but horizontal margin diagnosis was difficult mainly owing to exfoliation and/or cauterization damage of the end of the mucosa. 27 Moreover, the clinical significance of surgical margin positivity has not been well discussed.…”

“…One RCT and 2 observational studies provided data on the rate of surgical margin diagnosis of ERBT. 11,29,51 Pooled rates of surgical margin diagnosis in ERBT specimen were 85% (191/224). On the other hand, in some cases the cTURBT specimen allowed evaluation of the surgical margin, specifically vertical margins.…”

Do we need repeat transurethral resection after en bloc resection for pathological T1 bladder cancer?

“…We found no residual disease and no recurrence overtime at the initial ERBT site in patients with negative horizontal margins. The association between surgical margins and oncological outcomes in NMIBC remain poorly investigated/ understood [14,21,22]. Gakis et al [21] showed that patients with NMIBC who underwent ERBT with negative surgical margins were less likely to experience intravesical recurrence, resulting in a favourable 12-month RFS compared to those with positive surgical margins.…”

“…Theoretically, ERBT allows the assessment of horizontal and vertical margins. However, only a few studies reported the diagnostic rate of surgical margins with a success range from 63% to 95% [ 14 , 21 , 22 ]. The present study showed that the diagnostic rate of horizontal and vertical margins was 84% and 97%, respectively.…”

“…We found no residual disease and no recurrence overtime at the initial ERBT site in patients with negative horizontal margins. The association between surgical margins and oncological outcomes in NMIBC remain poorly investigated/understood [ 14 , 21 , 22 ]. Gakis et al.…”