Clinical Study On The Treatment Of En Bloc Transurethral Resection Of Bladder Tumors With Needle Electrode And Repeat Transurethral Resection For Bladder Cancer

Purpose: 1.Treatment of en bloc transurethral resection of bladder tumors(ERBT)is an improved procedure of traditional transurethral resection of bladder tumor(TURBT),which effectively overcomes the shortcomings of low accuracy of postoperative tumor pathological evaluation and increased risk of recurrence.However,ERBT treatment has not yet been standardized.The purpose of this research is to evaluate the safety and effectiveness of the technology.2.To systematically evaluate the risk factors that affect the positive pathological tumor in patients with non-muscular invasive bladder cancer(NMIBC)after resection.Methods: In the first part,we collected 34 patients who were newly diagnosed with bladder cancer from January 2016 to January 2019 and received treatment of en bloc transurethral resection of bladder tumors with needle electrode,and recorded the operation process,analyze the pathological results and the incidence of intraoperative and postoperative complications.In the second part,we continue to collect patient data until September 2020,and divide patients with non-muscular invasive bladder cancer into the experimental group receiving ERBT treatment and the control group receiving traditional TURBT,compare the recurrence rate through the Kaplan-Meier curve adjusted by propensity score matching(PSM)analysis.In addition,we analyzed the independent risk factors that affect the recurrence rate of NMBIC through COX risk regression.In the third part,we searched PubMed,EMbase,Cochrane database,CNKI,VIP and WanFang data database through computer to collect case studies on the positive risk factors of resection of NMIBC patients with pathological tumors.The search time limit is limited to the establishment of the database until January 2020.Multiple researchers independently screened the literature,extracted the data,and used RevMan 5.3 software for Meta analysis;Results: In the first part,we collected 34 patients from January 2016 to January2019.A total of 66 tumors were removed,with an average tumor diameter of 1.9 ±1.01 cm.The average operation time was 57.6±22.2min.The average intraoperative blood loss was 24.9±18.7 mL,one case of obturator reflex occurred during the operation,and no bladder perforation occurred.Pathological evaluation showed that20 cases(58.8%)were found in pathological stage ≤ T1,and 14 cases were in T2(41.2%);pathological grade: 1 case(2.9%)with low-grade malignant potential,22cases(64.7%)with low-grade potential,and high-grade 11 cases(32.4%).Follow-up(7～41)months,the 7-month recurrence rate of patients with case stage ≤ T1 and T2 were 15%(3/20)and 35.7%(5/14),2 patients with T2 stage had tumor progression,≤There is no tumor progression in patients with T1 stage.In the second part,from February 2016 to September 2020,222 NMBIC patients were enrolled,48 patients in the experimental group receiving ERBT treatment,and 174 patients in the control group receiving TURBT treatment.After PSM,the total recurrence rates of the experimental group and the control group(40 vs 40)were 17.5% and 25.0%(P=0.652),respectively.The 6-month recurrence rates were? And the 1-year recurrence rates were ?,What are the 3-year recurrence rates? There was no statistical difference in the progress rate between the two groups(2.5% vs 12.5%,P=0.09).Comparing the perioperative data of the two groups,it was found that compared with TURBT,ERBT can reduce intraoperative bleeding(12.6±9.4 vs 16.7±6.2,P=0.04).Pathological grade and tumor size are independent factors affecting patient recurrence.In the third part,we included 17 studies with a total of 1877 patients.Meta analysis showed that: high-grade pathological grade(OR=0.35,95%CI(0.25,0.49),P <0.00001),tumor size ≥3cm(OR=0.40,95%CI(0.22,0.72),P=0.003),multiple tumors(OR=0.47,95%CI(0.37,0.61),P<0.00001),no detrusor muscle(OR=0.19,95%CI(0.09,0.39),P < 0.00001),concurrent carcinoma in situ(OR=0.99,95%CI(1.52,5.87),P=0.002),history of bladder tumor recurrence(OR=2.32),95% CI(1.30,4.13),P = 0.004),two treatments in different medical institutions(OR = 0.23,95% CI(0.12,0.45),P <0.00001)is the pathology of NMBIC patients after resection Risk factors for tumor positive.Conclusion: The treatment of en bloc transurethral resection of bladder tumors with needle electrode as a surgical procedure for the treatment of bladder tumors,compared with traditional TURBT treatment,has less intraoperative bleeding and high surgical safety.At the same time,the treatment of en bloc transurethral resection of bladder tumors with needle electrode can obtain high-quality pathological specimens,which has obvious advantages in postoperative pathological evaluation.In terms of recurrence-free survival,there is no difference between overall enucleation and traditional electrosurgical surgery.In addition,current evidence shows that high-grade pathological grade,tumor size ≥3cm,multiple tumors,no detrusor muscle in the first resection tissue,and concurrent carcinoma in situ are risk factors for tumor-positive pathology in NMBIC patients after re-TURB.Patients with similar pathological specimens from the first resection are more likely to have residual tumors.It is recommended to perform a second resection in time to reduce the recurrence rate after surgery.