Residual tumour in the marginal resection after a complete transurethral resection is associated with local recurrence in Ta/T1 urinary bladder cancer

Abstract Objective. This study investigated the presence of residual tumour in the marginal resection (MR) after a complete transurethral resection (TURB) of Ta/T1 transitional urinary bladder cancer. The association between positive MR and recurrence was analysed. Material and methods. After macroscopically complete TURB, a marginal resection of 7 mm (corresponding to the diameter of the resection loop) was removed around the entire resection area. Univariate and multivariate Cox regression analyses were performed to assess the influence of residual disease on recurrence. Results. In all, 94 patients with a median follow-up time of 36 months were included, and residual tumour in the MR was present in 24 (26%). The recurrence rates for all cases, for those with a tumour-positive and a tumour-free MR were 60 (64%), 20 (83%) and 40 (57%), respectively. Local recurrence was found in 14 (58%) of the patients with tumour presence in the MR compared to 13 (19%) of those with a tumour-free margin. A positive MR was significantly associated with overall recurrence (p < 0.001) and local recurrence (p = 0.001). Conclusion. Incomplete transurethral resection of bladder cancer is common, as demonstrated in 26% patients with positive MR. The presence of tumour in the MR may be a risk factor for recurrence, and particularly local recurrence.     

Therapeutic benefit of second-look transurethral resection of bladder tumors for newly diagnosed T1 bladder cancer: a single-center experience

International Urology and Nephrology - In recent years, second-look transurethral resection of bladder tumors (TURBT) has been recommended for patients with stage T1 bladder cancer after the...     

CEA-directed second-look surgery in the asymptomatic patient after primary resection of colorectal carcinoma.

Since 1971, serial carcinoembryonic antigen (CEA) levels have been measured to monitor patients after primary resection of colorectal cancer. Based solely on a rise in CEA level above the baseline established after primary resection, 146 patients were readmitted to the hospital. Chest films, liver-spleen scan, colonoscopy, bone scan, abdominal and pelvic CAT scan, and hepatic arteriograms were performed, and elevated CEA levels were confirmed before reexploration was undertaken. In the 146 patients, 139 (95%) had recurrences, and 81 (58%) of these were resectable for potential cure. Two of the first 22 patients re-explored between 1971 and 1975 are still living 11 and 14 years after second look; of 45 patients reoperated upon from 1976 through 1979 and followed for at least 5 years, 14 (31%) are still living. A rise in CEA above the baseline established after primary resection proved to be a sensitive indicator of recurrence and prompted reexploration before symptoms developed. Early alternative therapy was begun in patients with unresectable recurrences.     

Transurethral resection and sequential chemo-immunoprophylaxis in primary T1G3 bladder cancer

OBJECTIVES: T1G3 superficial bladder cancer is considered to be at high risk for progression, and in some institutions early cystectomy is advocated. Other authors and personal experience suggest that conservative treatment, such as TURBT followed by intravesical prophylaxis, may be adequate in the majority of cases. The purpose of the present phase II study was to assess the tolerability and efficacy of sequential intravesical administration of a chemotherapeutic agent, epirubicin, followed by BCG, after TURBT. MATERIALS AND METHODS: 81 patients with primary T1G3 superficial bladder cancer, without evidence of Tis or upper tract tumor, underwent TURBT and intravesical prophylaxis with weekly epirubicin 50 mg for 8 weeks followed by weekly BCG Connaught 120 mg for 6 weeks. A control cystoscopy with bladder mapping and/or TUR of suspicious areas was performed at 15-17 weeks. Then patients were followed-up with 3-month urinary cytology and cystoscopy. RESULTS: The sequential chemo-immunoprophylaxis was generally well tolerated. After a mean follow-up of 48 months recurrent tumors were found in 19 patients (23.4%) and progressive disease in 6 cases (7.4%). Of 6 progressions, 4 patients died (5%) of the disease. CONCLUSION: Sequential chemo-immunoprophylaxis with epirubicin followed by BCG is well tolerated and seems to be efficacious in primary T1G3 bladder cancer. The recurrence progression and disease-specific mortality rates were acceptable so that this study seems to confirm previous data which show that TURBT and intravesical prophylaxis are appropriate treatment for the majority T1G3 tumors.     

Composite paraganglioma-ganglioneuroma of the urinary bladder: a rare neoplasm causing hemodynamic crisis at tumour resection

A 64-year-old man presented with gross painless hematuria. Cystoscopy revealed a submucosal bladder neck mass covered by normal urothelium. During transurethral resection, the patient developed hemodynamic crisis including sinus bradycardia. Histopathologic examination revealed a primary bladder composite paraganglioma-ganglioneuroma (CPG). The patient underwent partial cystectomy and is symptom-free after one year. Bladder CPGs are extremely rare neoplasms that may result in life-threatening catecholamine secretion, especially during tumour manipulation. These tumours require complete surgical excision and should be included in the differential diagnosis of any solitary bladder mass covered by normal urothelium, especially when there is a history of hypertension or micturition attacks.     

原发性T1G3膀胱癌复发后病理分级减低现象的临床意义

目的 探讨原发性T1G3膀胱癌复发后病理分级减低现象的临床意义。方法 回顾性分析1995年至2004年收治55例原发性T1G3膀胱癌患者的临床资料。55例首次手术方法均采取经尿道膀胱肿瘤电切术，术后均出现复发，次数1～9次。依据复发后是否发生病理分级减低分为2组：A组21例（38．2％），复发后有病理分级减退现象；B组34例（61．8％），复发后病理级别不变。对2组患者性别、年龄、肿瘤大小、是否多发、术后是否膀胱灌注、复发后肿瘤是否浸润肌层、肿瘤病理分级改变以及无瘤生存期等资料进行对比分析。结果 A组原发肿瘤直径〉3cm者9．5％（2／21），复发后肿瘤肌层浸润者23．8％（5／21）；而B组分别为38．2％（13／34）和52．9％（18／34），2组差异有统计学意义（P=0．020，0．033）。2组患者5年无瘤生存率分别为（66．8±16．6）％和（50．5±12．9）％，差异有统计学意义（P=0．038）。Cox多因素回归分析显示，病理分级减退现象为影响生存率的独立指标（P=0．044）。结论 原发性T1G3膀胱癌患者复发后病理分级减低者预后相对较好，复发后病理分级减低可作为判断预后的独立因素。     

再次经尿道电切术治疗T1期膀胱肿瘤

目的 评价再次经尿道电切术治疗T1期膀胱癌的疗效.方法 48例初次电切术后的T1期膀胱癌患者,4~6周后行再次经尿道电切术(Re-TURbt).结果 48例患者均手术成功.48例患者中,33.3%(16/48)发现有肿瘤残留,其中11例肿瘤未侵犯肌层,Ta期4例,T1期7例;5例(10.4%)肿瘤侵犯肌层,分期被低估.随访6～26个月,有5例复发.结论 T1期膀胱癌患者术后4~6周后行Re-TURbt能发现残留肿瘤,提高分期的准确性.     

Stage T1 adenocarcinoma of the urinary bladder--complete response after transurethral resection and intravesical bacillus Calmette-Guerin

OBJECTIVE: To report the results of treatment of adenocarcinoma of the urinary bladder with transurethral resection and intravesical bacillus Calmette-Guerin (BCG). METHODS: Out of 183 patients in our department treated with BCG between 1992 and 1996, three patients had adenocarcinoma, stage T1. RESULTS: All three patients had normal cystoscopy and negative cytology 53-82 months after the start of treatment. CONCLUSIONS: BCG appears to be effective not only in the treatment of transitional cell carcinoma, but also in adenocarcinoma of the bladder.     

Immediate administration of intravesical mitomycin C after tumour resection for superficial bladder cancer

OBJECTIVE: To assess the feasibility and safety of administering intravesical mitomycin C in theatre immediately after transurethral resection of bladder tumour (TURBT). PATIENTS AND METHODS: A protocol was developed to allow the safe administration of mitomycin C in theatre immediately after TURBT. Over a 32-month period all patients not excluded by the protocol were given mitomycin C in theatre after TURBT, and any adverse events reported. RESULTS: In all, 177 instillations were carried out; there were two minor patient-related complications, and no staff-related adverse events. CONCLUSION: The immediate administration of mitomycin C in theatre after TURBT is feasible and safe for patients and staff. It provides the earliest and surest prophylaxis against tumour cell re-implantation at TURBT.