| Background and Objective:The progression of bladder tumor recurrence is related to a number of factors: incomplete resection,tumor cell replantation,microscopic tumor growth,and new tumor formation.The first two mechanisms are influenced by the experience and operation of the urologist,while the tumor cell shedding is implanted.It is considered to be the main cause of early recurrence of bladder cancer.In the conventional transurethral resection of bladder tumor(cTURBT),the tumor is chopped and removed,so that a large number of tumor cells are scattered throughout the bladder,which may occur,such as dispersal,sowing and re-up of tumor cells.High risk of implantation.The en-bloc resection of bladder tumor(ERBT)procedure theoretically maintains the integrity of the tumor,avoiding tumor fragmentation,reducing the shedding of tumor cells,and reducing intravesical tumors.The chance of cell growth leading to recurrence.This study was designed to compare the effects of ERTB and cTURBT on tumor cell shedding in the treatment of NIMBC.The relationship between the two surgical methods and the prognosis of patients was compared by regular treatment and regular follow-up.Materials and Method:The study was included in the Second Hospital of Tianjin Medical University from April 2016 to November 2017.The findings were confirmed by cystoscopy,ultrasound,CT,MRI,urine exfoliation cytology and DNA ploidy analysis.132 patients with single-onset bladder tumor were assigned to cTURBT group and ERBT group.The two groups were included in 66 patients,with an average age of 66.8(±11.05)years.The patient took the lithotomy position during operation and placed the transurethoscope through the urethra.Firstly,the position,size and shape of the tumor were carefully observed and recorded.According to different groups,two different experienced physicians performed different operations,the surgeons used the British Jiale plasma bipolar resectoscope(ring electrode)to complete the operation,and the intraoperative irrigation solution was established.The protocol was used to obtain the intraoperative lavage fluid,and then the DNA ploidy analysis was performed on the specimens to compare the tumor cell detachment of the two groups.The two groups of patients were given a three-chamber balloon catheter.Immediately after the bladder was continuously flushed,the tumor specimens were preserved in formalin solution for histopathological examination.Patients were intraperitoneally injected with epirubicin within 12 hours after surgery.All patients received continuous intravesical instillation of BCG or Intravesical chemotherapy(epiubicin or gemcitabine),all patients were followed up for at least 1 year.Cystoscopy was performed every 3 months.During the follow-up period,the urologist improved follow-up examinations such as color Doppler ultrasound and exfoliated cells according to the patient’s condition.From the date of surgery to the date of recurrence The time to recurrence was calculated.The patients who did not relapse were observed until the end of follow-up.The primary endpoints were recurrence-free survival time and progression-free survival time.Result:A total of 132 patients with bladder cancer were excluded.11 cases of pathological reports were excluded: CIS tumors(6 cases)and T2 grade tumors(5 cases).Of the 121 patients who met the analysis criteria,97 were male and 24 were female,60 were in the cTURBT group,and 61 were in the ERBT group.The average diameter of the tumor was 2.11 ± 0.70 cm.All patients were successfully operated.There were no serious complications such as uncontrollable bladder perforation and major bleeding during and after surgery.DNA aneuploidy examination by intraoperative intravesical washing fluid samples confirmed that the ERBT group had fewer tumor exfoliated cells and a stable overall trend,which was significantly better than the cTURBT group(P=0.00).However,for larger(diameter > 2 cm)tumors,the removal of specimens after resection was a challenge.All patients were not lost after a regular follow-up plan.The median follow-up time was 19 months(12-27 months).The patient recurrence rate was 20.7% in the first year after follow-up,and the overall recurrence rate was 27.3% at the end of follow-up.Kaplan-Meier analysis of recurrence-free survival time showed no significant difference between the two groups(RFS,P=0.660);There was no significant difference in progression-free survival between the patients of two groups(PFS,P=0.694).Conclusion:Compared with cTURBT,ERBT reduces the intraoperative tumor fragmentation and dissemination to a certain extent.At the same time,adequate bladder irrigation and timely postoperative intravesical infusion of the bladder are necessary.There was no statistically significant difference in the ERBT group compared with the control group despite the tendency to delay recurrence and delay progression. |
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