Analysis of the effect of a second transurethral resection for non-muscle invasive bladder cancer
Ding Xianchao, Song Liming, Wasilijiang·Wahafu, Niu Yinong
2019, 40(1):
84-89.
doi:10.3969/j.issn.1006-7795.2019.01.015
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Objective To investigate the clinical efficacy of the first transurethral resection of bladder tumor (TURBT) vs. repeated TURBT (Re-TURBT) in the treatment of non-muscle invasive bladder cancer and study the clinical significance and indications of Re-TURBT. Methods The 56 cases of non-muscle invasive bladder cancer undergoing surgical treatments in our hospital from January 2011 to June 2017 were divided into two groups:31 patients undergoing conventional TURBT (control group) and 25 cases undergoing Re-TURBT about 8 weeks after the first TURBT (observation group). Both groups of patients received immediate postoperative bladder perfusion and maintain intravesical instillation. Postoperative recurrence rate and progress rate were compared with each other between two groups. Results There was no significant difference in gender(χ2=0.144,P>0.05), age(t=-1.03,P>0.05), number of tumor(χ2=0.750,P>0.05), stage of tumor(χ2=0.120,P>0.05), grade of tumor(χ2=0.002,P>0.05)between two groups. All cases were followed up for 6-24 months. Of the observation group, 3 cases had residual neoplasms, including 2 in Ta and 1 in T1. A total of 5 cases of recurrence in observation group, including 2 cases in Ta and 2 cases in T1, 1 case of progress from T1 to T2 after 11 months of Re-TURBT. There were 17 cases of recurrence in control group, including 12 cases in Ta and 4 cases in T1, and 1 case of progress from T1 to T2 after 18 months of Re-TURBT. There was significant difference in postoperative recurrence rate between two groups(χ2=7.042,P<0.05). No serious complications such as bladder perforation, ureterostoma injury and massive hemorrhage occurred in the two groups. Cystoscopy was re-examined every 3 months after surgery in both groups, and blood routine, urine routine and biochemical liver function were also re-examined to observe postoperative recurrence and progression in the two groups. Conclusion TURBT for non-muscle invasive bladder cancer is prone to recurrence or progression. For the patients with the first TURBT of tumor stage ≥ T1, high grade tumor (G2 and G3), tumor size ≥ 3 cm or multiple tumors (≥ 3 or more), the re-TUBRT can detect and remove the residual tumor at an early stage, and significantly decrease the recurrence rate of non-muscle-invasive bladder cancer. The specimens with smooth muscle tissue are helpful for accurate assessment of tumor pathological staging.
