Abstract
Purpose
To investigate the role of en bloc re-resection (EBRS) in patients who had undergone previous en bloc resection for high-risk non-muscle-invasive bladder cancer (NMIBC).
Methods
An international, multicenter, observational retrospective analysis of prospectively collected data. Patients with a high-risk NMIBC who had previously undergone en bloc resection were scheduled for EBRS of the resected area after 40 days. The primary outcome was the presence of residual tumor or recurrence-free survival.
Results
Overall, 78 patients underwent EBRS. Only five (6.41%) residual cancers were found: one patient had a pTa G3 (1.28%) cancer and four (5.13%) had a pTis. The detrusor muscle was preserved in all samples. Only one patient had a positive margin on EBRS. No procedure called for a conversion to traditional re-TURBT. No patient experienced bladder perforation or other intra-operative complications. The recurrence rate at the first follow-up cystoscopy (RRFF-C at 3 months) was 3.85% (three patients). The median follow-up period was 30.8 months (range 6.9–76.0 months). In univariate analysis, the only predictor of recurrence was grade. Overall we observed 11 recurrences. Only one tumor progressed to T2 MIBC.
Conclusions
The low rates of residual tumor, recurrence, and progression seem to raise doubts about the efficacy of EBRS in patients who have previously undergone en bloc resection. EBRS appears to be a feasible and safe procedure with a low rate of complications. However, further data will be needed before EBRS can be used in clinical trials or recommended as a treatment modality.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Grimm MO, Steinhoff C, Simon X et al (2003) Effect of routine repeat transurethral resection for superficial bladder cancer: a long-term observational study. J Urol. https://doi.org/10.1097/01.ju.0000070437.14275.e0
Di̇vri̇k RT, Yildirim Ü, Zorlu F, Özen H (2006) The effect of repeat transurethral resection on recurrence and progression rates in patients with T1 tumors of the bladder who received intravesical mitomycin: a prospective, randomized clinical trial. J Urol 175:1641–1644. https://doi.org/10.1016/S0022-5347(05)01002-5
Neuzillet Y, Methorst C, Schneider M et al (2014) Assessment of diagnostic gain with hexaminolevulinate (HAL) in the setting of newly diagnosed non-muscle-invasive bladder cancer with positive results on urine cytology. Urol Oncol Semin Orig Investig. https://doi.org/10.1016/j.urolonc.2014.04.005
Gendy R, Delprado W, Brenner P et al (2016) Repeat transurethral resection for non-muscle-invasive bladder cancer: a contemporary series. BJU Int. https://doi.org/10.1111/bju.13265
Naselli A, Hurle R, Paparella S et al (2017) Role of restaging transurethral resection for T1 non-muscle invasive bladder cancer: a systematic review and meta-analysis. Eur Urol Focus 4(4):558–567
Sfakianos JP, Kim PH, Hakimi AA, Herr HW (2014) The effect of restaging transurethral resection on recurrence and progression rates in patients with nonmuscle invasive bladder cancer treated with intravesical bacillus Calmette-Guérin. J Urol. https://doi.org/10.1016/j.juro.2013.08.022
Bishr M, Lattouf JB, Latour M, Saad F (2014) Tumour stage on re-staging transurethral resection predicts recurrence and progression-free survival of patients with high-risk non-muscle invasive bladder cancer. J Can Urol Assoc. https://doi.org/10.5489/cuaj.1514
Hurle R, Lazzeri M, Colombo P et al (2016) “En Bloc” resection of nonmuscle invasive bladder cancer: a prospective single-center study. Urology. https://doi.org/10.1016/j.urology.2016.01.004
Kramer MW, Altieri V, Hurle R et al (2017) Current evidence of transurethral en-bloc resection of nonmuscle invasive bladder cancer. Eur Urol Focus 3:567–576. https://doi.org/10.1016/j.euf.2016.12.004
Babjuk M, Böhle A, Burger M et al (2017) EAU guidelines on non–muscle-invasive urothelial carcinoma of the bladder: update 2016. Eur Urol 71:447–461. https://doi.org/10.1016/j.eururo.2016.05.041
Onishi T, Sasaki T, Hoshina A, Yabana T (2011) Continuous saline bladder irrigation after transurethral resection is a prophylactic treatment choice for non-muscle invasive bladder tumor. Anticancer Res 31:1471–1474
Onishi T, Sugino Y, Shibahara T et al (2017) Randomized controlled study of the efficacy and safety of continuous saline bladder irrigation after transurethral resection for the treatment of non-muscle-invasive bladder cancer. BJU Int 119:276–282. https://doi.org/10.1111/bju.13599
Böhle A, Leyh H, Frei C et al (2009) Single postoperative instillation of gemcitabine in patients with non-muscle-invasive transitional cell carcinoma of the bladder: a randomised, double-blind, placebo-controlled phase III multicentre study. Eur Urol 56:495–503. https://doi.org/10.1016/j.eururo.2009.06.010
Humphrey PA, Moch H, Cubilla AL et al (2016) The 2016 WHO classification of tumours of the urinary system and male genital organs—Part B: prostate and bladder tumours. Eur Urol 70:106–119. https://doi.org/10.1016/j.eururo.2016.02.028
Vianello A, Costantini E, Del Zingaro M et al (2011) Repeated white light transurethral resection of the bladder in nonmuscle-invasive urothelial bladder cancers: systematic review and meta-analysis. J Endourol. https://doi.org/10.1089/end.2011.0081
Grossman HB, Stenzl A, Fradet Y et al (2012) Long-term decrease in bladder cancer recurrence with hexaminolevulinate enabled fluorescence cystoscopy. J Urol. https://doi.org/10.1016/j.juro.2012.03.007
Naito S, Algaba F, Babjuk M et al (2016) The Clinical Research Office of the Endourological Society (CROES) multicentre randomised trial of narrow band imaging–assisted transurethral resection of bladder tumour (TURBT) versus conventional white light imaging–assisted TURBT in primary non-muscle. Eur Urol. https://doi.org/10.1016/j.eururo.2016.03.053
Naselli A, Puppo P (2017) En bloc transurethral resection of bladder tumors: a new standard? J Endourol 31:S20–S24. https://doi.org/10.1089/end.2016.0534
Saito S (2001) Transurethral en bloc resection of bladder tumors. J Urol 166:2148–2150
Author information
Authors and Affiliations
Contributions
CP: data collection and management; CD: data collection and management; CP: data analysis; HM: data analysis; HTRW: protocol/project development; HR: protocol/project development; OD: data collection and management; KT: data collection and management; LM: manuscript writing/editing, supervision; LL: protocol/project development; MM: data collection and management; ME: statistical analysis; PM: manuscript writing/editing; SA: data collection and management.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee, the 1964 Helsinki declaration and its later amendments, or comparable ethical standards.
Informed consent
The IRB approved the study and patients consented to data analysis. Informed consent was obtained from all persons included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Hurle, R., Casale, P., Lazzeri, M. et al. En bloc re-resection of high-risk NMIBC after en bloc resection: results of a multicenter observational study. World J Urol 38, 703–708 (2020). https://doi.org/10.1007/s00345-019-02805-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-019-02805-8