Abstract: PD48-04
Sources of Funding: None.

Introduction

Transurethral resection (TUR) is standard therapy for non-muscle invasive bladder cancer (NMIBC). Radical resection is an important predictor for outcome, and accurate pathological diagnosis is the key determinant factor to decide treatment strategy after TUR. In short, TUR are expected to complete excision and accurate pathological diagnosis for improved the prognosis in patients with NMIBC. Although TUR methods are established, pathological diagnosis is difficult because of heat denaturation and burn mark. In recent years, transurethral En-bloc resection technique is reported to be useful for judging cancer invasion in NMIBC. However, such method has disadvantage in prolongation of surgical time, particularly in large tumors. In this study, we investigated the usefulness and safety of combination therapy of electrical En-bloc resection and endoscopic mucosal resection (En-bloc + EMR) in NMIBC patients.

Methods

We analyzed 30 patients who were clinically diagnosed with NMIBC. The median of the tumour diameter was 30 (15–55) mm. At first, a tumour mass was cut by using CAPTIVATOR II (Boston Scientific) in the same way as EMR. Subsequently, a circular incision was created around the residual tumour, maintaining a distance of approximately 5–10 mm from the tumour edge, for the En-bloc resection. For the control, TUR was performed in 16 patients that were matched for tumour diameter and clinical stage. All surgeries were performed by one urologist. Before the patients were enrolled, the institutional ethical committee approved the study, and written informed consent was obtained.

Results

The mean operation time for EMR and En-bloc resection was 1.2 and 13.9 min respectively and total operation time was 15.0 min. That was similar to that for TUR (P = 0.94, mean = 16.2 and SD = 3.8 min). One patients had mild perforation of the bladder. However, no severe complications were observed and no significant difference was found regarding periods of catheterization and hospitalization. The pathologists can diagnose the invasion status with considerable certainty in all specimens obtained by En-bloc + EMR, compared to by TUR because of less heat denaturation and burn mark._x000D_ _x000D_

Conclusions

Our results showed En-bloc + EMR technique is a useful and safe. We believe that this technique is particularly suitable for large tumors because control of bleeding and visual field are clearly better than TUR. In addition, this technique has an advantage in accurate pathological diagnosis to distinguish pTa and pT1.

Funding

None.