膀胱癌術後立即膀胱內化療灌注之時間分析：比較6小時內與24小時內灌注之成效

陳正宇、曾文歆、黃冠華¹

奇美醫療財團法人永康奇美醫院外科部泌尿外科

Impact of the Timing of Immediate Postoperative Intravesical Chemotherapy : A Comparison of Instillation within 6 Hours versus 24 Hours

Cheng-Yu Chen, Weng-Shin Tzeng, Steven Kuan-Hua Huang

Division of Urology, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan

Purpose: Immediate postoperative intravesical chemotherapy (IVC) is recommended to reduce recurrence in non-muscle invasive bladder cancer (NMIBC). However, the optimal "immediate" window remains a subject of debate, particularly for T1 patients. This study aims to compare the oncological outcomes and complication rates between T1 bladder cancer patients receiving IVC within 6 hours versus those receiving it between 6 and 24 hours post-TURBT.

Materials and Methods: We retrospectively reviewed T1 bladder cancer patients who underwent transurethral resection of bladder tumor (TURBT) followed by a single instillation of chemotherapy (e.g., Mitomycin-C or Epirubicin) at our institution between 2018 and 2022. Patients were categorized into two groups based on the timing of instillation: Group A (<6 hours) and Group B (6–24 hours). Primary endpoints included recurrence-free survival (RFS) and cancer-specific survival (CSS). Secondary endpoints were the incidence of postoperative complications (e.g., chemical cystitis, hematuria, or bladder perforation).

Results: A total of 150 patients were included (Group A: n=60; Group B: n=90). The median follow-up was 22 months. The recurrence rate in Group A was 7% compared to11% in Group B (p = 0.65). There was no significant difference in the 3-year cancer-specific survival between the two groups (1.3% vs. 2.2%, p = 0.98). Overall complication rates were 5% in Group A and 2% in Group B (p = 0.07). No Grade 3 or higher Clavien-Dindo complications were observed related to the timing of instillation.

Conclusions: Our findings suggest that administering intravesical chemotherapy within 6 hours shows comparable oncological outcomes compared to administration within 24 hours for T1 bladder cancer. Furthermore, instillation within the 6-hour window did not increase the risk of postoperative complications, supporting its safety and efficacy in clinical practice.