Long-term Follow-up After En Bloc Transurethral Resection of Non-muscle-invasive Bladder Cancer: Results from a Single-center Experience

Marco Paciotti, Paolo Casale, Piergiuseppe Colombo, Vittorio Fasulo, Alberto Saita, Giovanni Lughezzani, Roberto Contieri, Nicolò Maria Buffi, Massimo Lazzeri, Giorgio Guazzoni, Rodolfo Hurle, Marco Paciotti, Paolo Casale, Piergiuseppe Colombo, Vittorio Fasulo, Alberto Saita, Giovanni Lughezzani, Roberto Contieri, Nicolò Maria Buffi, Massimo Lazzeri, Giorgio Guazzoni, Rodolfo Hurle

Abstract

Background: En bloc resection (ERBT) is a valid alternative to piecemeal resection for non-muscle-invasive bladder cancer (NMIBC), guaranteeing pathological outcomes. However, very few studies investigated long-term oncological outcomes of ERBT.

Objective: To report long-term oncological outcome of ERBT.

Design setting and participants: This is a retrospective analysis of prospectively collected data. We included patients who underwent ERBT from June 2010 to February 2014, and were diagnosed with NMIBC at pathology evaluation.

Outcome measurements and statistical analysis: The primary study endpoint was recurrence-free survival at 5 yr. Secondary outcomes were presence of detrusor muscle, recurrence rate at the first follow-up cystoscopy, progression to muscle-invasive bladder cancer (MIBC) at 5 yr, and factors associated with long-term oncological outcomes. Kaplan-Meier curves were used to describe recurrence-free survival time. A univariate analysis was used to investigate factors associated with recurrence.

Results and limitations: Overall, 74 patients were included in this study. The median age was 71 (66-76) yr. Most of the patients presented with only one bladder tumor, and the median tumor diameter was 2 (interquartile range [IQR] 1-2.5) cm. After histopathological examination, eight, 35, and 31 patients were diagnosed with low-, intermediate-, and high-risk disease, respectively. All the en bloc resected tumors showed the presence of detrusor muscle. The median follow-up was 72 (IQR 66-90) mo. The recurrence rate at the first follow-up cystoscopy was 5.4% (four out of 74 patients). Overall, 57 (77%) patients were free of recurrence at 5 yr. No progression to MIBC was observed: progression-free survival was 100%. Limitations include retrospective design and small size.

Conclusions: Our findings showed that ERBT for NMIBC presents an optimal long-term oncological outcome. Further studies with larger cohorts are necessary for confirming our preliminary results and for a direct comparison with the traditional piecemeal resection.

Patient summary: In case of superficial bladder tumors, transurethral resection of the entire tumor and its base in one piece seems to provide good long-term results in terms of recurrence and progression rates.

Keywords: En bloc resection; High grade non–muscle-invasive bladder cancer; Long-term outcomes; Non–muscle-invasive bladder cancer; Transurethral resection of bladder tumor.

© 2021 The Author(s).

Figures

Fig. 1
Fig. 1
Stages of en bloc resection of bladder tumor. (A) Initial incision: a circular incision is performed in macroscopically “normal” mucosa surrounding the base of the tumor, maintaining a distance of approximately 5–10 mm from the tumor edge. (B) Resection of the tumor base: the incision is extended through the subepithelial connective tissue, muscularis mucosae, and muscularis propria layers. (C) Tumor traction: a gentle traction can be applied from the base of the tumor upward, in order to detach the muscle fibers. (D) Resection bed: a view of the resection bed after tumor detachment. In many cases, the procedure is virtually bloodless.
Fig. 2
Fig. 2
High-grade pTa papillary urothelial carcinoma. Example of an en bloc resection specimen in which the tumor staging results are accurate. Note that with a wall section of the tumor, the peripheral margin and the deep margin are easily identifiable (hematoxylin and eosin, original magnification 20×). The arrow indicates lamina propria and asterisk indicates muscularis propria. DM = deep margin; PM = peripheral margin; T = tumor.
Fig. 3
Fig. 3
Kaplan-Meier curve examining recurrence-free survival in patients undergoing en bloc resection for non–muscle-invasive bladder cancer.

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Source: PubMed

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