BACKGROUND: Conventional transurethral resection of urinary bladder tumour (TURBT) using a wire loop diathermy violates the basic principle of oncological surgery, i.e. dissection through normal tissue. However, in the en bloc technique, the tumour is removed as a single specimen. We compared the quality of specimen and recurrence rate at three months (first check cystoscopy) in both the en bloc and conventional resection techniques. METHODS: The subject accrual was done from June 1st, 2017 till June 30th, 2019 at a tertiary care hospital. Patients with newly diagnosed bladder tumour, solitary or multiple ≤3 cm were included in the study. Patients with carcinoma in situ, prior TURBT, or muscle-invasive bladder cancer were excluded. Eighty-two patients were available for final analysis, 41 in each group. RESULTS: Mean age, gender ratio, tumour features (grade, stage, median number, and size) were comparable in the two groups. Median Operative time [interquartile range- (IQR)] was 30 (25-39.5) minutes in the en bloc group as compared to 45 (33-63.5) minutes in the conventional group (p < 0.001). The detrusor muscle was seen at the base of the primary tumour in all 41 (100%) en bloc cases as compared to 23 (56 %) cases in the conventional group (p<0.001). Overall recurrence at the first surveillance cystoscopy was 17%, with an insignificant difference between the groups. Recurrence at primary site was 19.5% in conventional TURBT compared to en bloc resection (n=1, 2.4%), (p = 0.013). CONCLUSIONS: En bloc resection decreases the recurrence rate at the primary site. En bloc TURBT is a safe technique, providing high-quality specimens for histopathological evaluation and reducing the need for the second TURBT.
BACKGROUND: Conventional transurethral resection of urinary bladder tumour (TURBT) using a wire loop diathermy violates the basic principle of oncological surgery, i.e. dissection through normal tissue. However, in the en bloc technique, the tumour is removed as a single specimen. We compared the quality of specimen and recurrence rate at three months (first check cystoscopy) in both the en bloc and conventional resection techniques. METHODS: The subject accrual was done from June 1st, 2017 till June 30th, 2019 at a tertiary care hospital. Patients with newly diagnosed bladder tumour, solitary or multiple ≤3 cm were included in the study. Patients with carcinoma in situ, prior TURBT, or muscle-invasive bladder cancer were excluded. Eighty-two patients were available for final analysis, 41 in each group. RESULTS: Mean age, gender ratio, tumour features (grade, stage, median number, and size) were comparable in the two groups. Median Operative time [interquartile range- (IQR)] was 30 (25-39.5) minutes in the en bloc group as compared to 45 (33-63.5) minutes in the conventional group (p < 0.001). The detrusor muscle was seen at the base of the primary tumour in all 41 (100%) en bloc cases as compared to 23 (56 %) cases in the conventional group (p<0.001). Overall recurrence at the first surveillance cystoscopy was 17%, with an insignificant difference between the groups. Recurrence at primary site was 19.5% in conventional TURBT compared to en bloc resection (n=1, 2.4%), (p = 0.013). CONCLUSIONS: En bloc resection decreases the recurrence rate at the primary site. En bloc TURBT is a safe technique, providing high-quality specimens for histopathological evaluation and reducing the need for the second TURBT.
Authors: D Oswald; P Pallauf; S Deininger; T R W Herrmann; C Netsch; B Becker; M Fiedler; A Haecker; R Homberg; J T Klein; K Lehrich; A Miernik; P Olbert; D S Schöb; K D Sievert; A J Gross; J Westphal; L Lusuardi Journal: Urologie Date: 2022-03-14
Authors: Pietro Diana; Andrea Gallioli; Matteo Fontana; Angelo Territo; Alejandra Bravo; Alberto Piana; Michael Baboudjian; Pavel Gavrilov; Óscar Rodriguez-Faba; Josep Maria Gaya; Ferran Algaba; Joan Palou; Alberto Breda Journal: World J Urol Date: 2022-05-31 Impact factor: 3.661