The value of extended transurethral resection of bladder tumour (TURBT) in the treatment of bladder cancer

Abstract

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Transurethral resection of bladder tumour (TURBT) is the ‘gold standard’ in the diagnosis and therapy of non‐muscle‐invasive bladder cancer. To improve the quality of this technique an additional TUR (after 4–6 weeks) or a simultaneous photodynamic diagnosis is often offered. The present study shows different variables that influence, to a greater or lesser extent, the accuracy of the TUR diagnosis and the success of the operation. This is very important for the further management of bladder cancer, be it in tumour follow‐up or in preparation for more invasive therapies. OBJECTIVE To analyse the impact of a standardised extended transurethral resection of bladder tumour (TURBT) protocol on the determination of the residual tumour status at initial TURBT session and recurrence rate in the primary resection area. Despite, the fact that there is a clear consensus on the aims of TURBT, there is little agreement on how to perform TURBT to achieve that goal. PATIENTS AND METHODS We retrospectively evaluated 221 consecutive patients, who underwent 305 TURBT sessions for bladder cancer, including patients with recurrent tumours. All the TURBTs were extended by taking additional deep and marginal specimens, according to a standardised protocol. Clinical and histopathological data were retrieved from the patients' records. RESULTS Across all tumour stages, residual tumour (pR1) was found in 38% of the additionally taken specimens. There was a significant association of pR1 status with tumour stage, grade, and size. Also in the group of non‐muscle‐invading tumours, the rate of R1 resection was rather high at 22%. There was no association with focality and the training status of the surgeon. At follow‐up, of all the patients with a unifocal primary tumour there was recurrence in the same area as the primary in 5.1%. CONCLUSIONS Extended TURBT provides detailed information about the horizontal and vertical extent of the bladder tumour. The implementation of standardised TURBT procedures, such as our protocol of an extended TURBT, is greatly needed to improve local tumour control. Whether a diagnostic re‐TUR may be restricted to those cases with positive margins or ground specimens remains to be studied.

Quality of transurethral resection of bladder tumor procedure influenced a phase III trial comparing the effect of KLH and mitomycin C

“…As suggested by Richsterstetter et al [8] and Brausi et al [9], suitable statistical procedures need to be utilized to account for interaction effect between product efficacy and multicenter effects before generalizing results of the clinical study. This additional confounding effect has to be taken into consideration when designing clinical trials with new drug products involving surgery as a prerequisite treatment step.…”

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

“…Richterstetter et al. [11] described a standardized extended delayed second TURBT protocol to investigate the best method of TURBT in 2001 and analyzed the impact of the protocol on the residual tumor status at the initial TURBT session and the recurrence rate in the primary resection area in 2012. After completing tumor resection, they obtained additional deep specimens from the center and from endoscopically “normal”‐appearing margin sites of the resection area.…”

“…Because there is a lack of standards regarding how to perform the initial TURBT, a standardized extended TURBT protocol was developed by Richterstetter et al. [11] in 2001. The study was designed to analyze the impact of this protocol on the determination of the residual tumor status at the initial TURBT session and the recurrence rate in the primary resection area [11].…”

“…[11] in 2001. The study was designed to analyze the impact of this protocol on the determination of the residual tumor status at the initial TURBT session and the recurrence rate in the primary resection area [11]. By contrast, Kim et al.…”

Homing peptide guiding optical molecular imaging for the diagnosis of bladder cancer

“…The limitations of primary TURBt have led many urologists to recommend early re-resection as a standard technique in bladder cancer treatment. Astonishingly, the re-resection residual rate of bladder cancers is as high as75% [3] .Subsequent modifications have been made in technique including complete transurethral resection of bladder cancer [4] , extended transurethral resection of bladder cancer [5] , en bloc resection [6] , and newer energy sources like laser, bipolar energy source, and photodynamic-assisted resection [7][8][9] .…”