| Bladder cancer is a common urology disease all over the world, ranked eleventh in the morbidity of malignant tumor, while seventh in male and after tenth in female. According to the latest reports in 2015,the morbidity of bladder cancer is ranked sixth in the United States after lungcancer, prostate cancer, breast cancer, colon cancer, and lymphoma, while the third in male but the eleventh in female. There are 74,000 new cases diagnosed as bladder cancer and 16,000 cases died of bladder cancerannually. In China the morbidity of bladder cancer is far lower than the western countries, ranked seventh in male and after tenth in female,it is 6.61/100000 in 2009, and thestandardization rate is 3.03/100000.Early detection and complete resectionare the best situations for treatment of bladder cancer. So how to diagnose and treat the non-muscule invasive bladder cancer as early stage of bladder cancer seems to be critically important. Transurethral resection(TUR-BT) is the standard treatment for the non-muscule invasive bladder cancer.However, in recent years a large number of studies have found that the recurrence rates were 65%, 81% and 88% respectively after 5 years,10 years, 15 years through conventional TUR – BT, the postoperative prognosis is not satisfied.In some reports, except the skills of surgeons and unstandardized TUR-BT, the tumor residual after single TUR-BT seems make more contributions to the high recurrence. As is reported in seven randomised trials, there is a significant difference among various medical institutions inearly tumor residual rate. 3 months recurrenceafter single TURBT ranges from 0 to 46% by different surgeons. High recurrence may be obtained even the single TUR-BT was performed by a experience durological surgeon. After second TUR-BT for 214 cases of stage Ta T1 bladder tumor patients, the residual tumorrate detected by high-level urological surgeonand residency are 37% and 26%respectively.Harry surgested that both the limits of TUR-BT technology itself and characteristics of the bladder tumor contributes to high residual rate, it is impossible to completely remove all visible multiple Ta tumer especially the T1 bladder tumor in one-stage, it may be overlooked because of the extensive growth or some regions of the bladder were difficult to reach, and also the difficulty to distinguish the tumor from the normal bladder tissues at cystoscopy while the tumor invasives surroundings and deeper. Through the resection proceeds, owing to mucosal edema,bladder spasmsand bleeding, vision often becomes bscured, which results more difficulty to differentiate the tumor from the normal bladder tissue.Since 1991, Klanputted forward the concept of secondary TUR-BT(currently secondary TUR-BT refers to transurethral resection performed after fist transurethral resection for 2-6 weeks). Fourther more studies about the secondary TUR-BT has been made, But there is no systematic review only included randomized controlled trials to evaluate the efficacy of the secondary TUR-BT.Objective: To evaluate the value of second transurethral resection and provide more credibleevidence for clinical treatment through systematically review randomized controlled trials.Methods: Searches were applied to following electronic database: 1.Pubmed(1980.1.1-2015.3.12) 2.ovid(1980.1.1-2015.3.1) 3.Cochranelibrary(1980.1.1-2015.3.1) 4.EMBASE(1980.1.1-2015.3.1) 5.WANFANG DATA(1980.1.1-2015.3.1) 6.CNKI(1980.1.1-2015.3.1) 7.CQVIP(1980.1.1-2015.3.1) 8.CBM(1980.1.1-2015.3.1).The following terms were used during the search: Urinary Bladder Neoplasms[Me SH] OR Neoplasm,Urinary Bladder OR Urinary Bladder Neoplasm OR Neoplasms, Bladder OR Bladder Neoplasms OR Bladder Neoplasm OR Neoplasm,Bladder OR Bladder Tumors OR Bladder Tumor OR Tumor, Bladder OR Tumors, Bladder OR Urinary Bladder Cancer OR Cancer, Urinary Bladder OR Malignant Tumor of Urinary Bladder OR Cancer of the Bladder OR Bladder Cancer OR Bladder Cancers OR Cancer, Bladder OR Cancer of Bladder OR bladder carcinogenesisre-TUR OR relook TURBT OR relook TUR OR second-look TUR OR second-look TURBT OR re-staging transurethal resection OR second transurethal resection OR repeated transurethal resection OR repeat transurethal resection OR re-resection OR second resection OR secondary transurethal resection. Only randomized controlled trials(RCTs) comparing Second Transurethral Resection with No second Transurethral Resection for non-muscle invasive bladder cance were included with limiting language in Chinese or English or other language which have complete english vision.Of 4346 paper we finded, only 6 met the inclusion criteria. The reason for most papers excluded is not randomized controlled trials. The methodological quality of trails was assessed by the tool of assessment of quality or systematic reviews of interventions from Cochraneweb.Results: We included 6 RCT, for a total of 688 patients(expermen t group 344, control group 344). All trail reported that experimental gro up and control group had no differences between the groups in age,sex,n umber of tumors,largest tumor diameter,stage,or tumor grade. All patientshad complete transurethral resection,which means resection to the depth of muscularis propria and remove all visible bladder cancer. Residual ra te at second transurethral resection have been reported to be present in 33.3% and 38.1% of patients in only 2 trials. The rate of upstaging of second transurethral resection reported to be 11.4%-19.0% of patients in3 trials(19.0%, 11.4%, 14.3%, respectively).The recurrence rate in exper imental group reported to be 13.8%-39.8%(17.0%, 39.8%, 13.3%, 38.0%,20%, 13.8%, respectively)comparded with control group 26.6%-71.4%(46.0%, 71.4%, 26.6%,68.0%, 60.0%, 37.0% respectively) in all 6 trials.The progression rate of experimental group reported to be 6.5%-37.5% comparded with control group 16.6%-70.6% in 3 trials(experimental grou p is 6.5%,10.0%,37.5% respectively,and control group 23.5%,16.6%,70.6% respectively).Conclusions:1 Based on the Residual rate and the rate of upstaging at second transurethral resection,even a complete and standardizedtransurethral resection may not complete remove all visible and invisible cancer.2 The data convincingly suggest that early second resection improves staging and reduces the recurrence as well as progression rates of non-muscle invasive bladder cance.3 However the few high-quality literature,selection bias,performance bias and publication bias possibility are likely to affect the reliability of the results.We should be cautious about these conclusions and expect best evidence from more high quality double blind randomized controlled trials. |
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