經尿道整塊膀胱腫瘤切除術能取代傳統經尿道膀胱腫瘤刮除手術重要性?

倪雪雰、王賢祥

台中榮總 外科部 泌尿外科

Can ERBT take place of the importance of traditional TURBt?

Hsueh-Fen Ni, Shian-Shiang Wang

Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital

Purpose:

Until now, the gold standard of managing non-muscle invasive bladder cancer (NMIBC) is still considering to be TURBT. However, there are still several concerns exist, including poor detrusor muscle sampling rate (related to poor staging accuracy), difficult assessment to resection margins. Besides, another concern is the risk of tumors re-implantation due to tumors fragmentation. We want to realized can en-bloc-resection of bladder tumor (ERBT) can overcome these difficulties

Materials and Methods:

From 2019/03, 16 patient under ERBT by the same physician was enrolled. The base of tumor was inked and fix with pins over cushion board. Post operation IVI protocol, patient basic data base, pathology report, and condition following up are all recorded.

Results:

Among 16 cases, 3 patient receive IVI MMC and another 5 receive IVI epirubicin post ERBT. Two patient received thulium laser TURP and ERBT at the same time. One patient receive partial cystectomy post ERBT considering tumor invasion to detrusor muscle. The pathology over the partial cystectomy with residual urothelial carcinoma in situ noted. Two case present tumor recurrence.

Conclusions:

Among all the patient group, except for the one with diffuse and muscle invasion UBUC, only two local recurrence case was report. Besides, if TURP was combination among the same surgery, ERBT may be better choice comparing with traditional TURBT, whiling considering the risk of tumors re-implantation. To sum up, as for pathology evaluation or oncology control, ERBT seemed to be a new way under consideration. However, due to the small size of patient and short following time, the study may still required further evaluation.