دور إعادة التجريف الباكر في خفض معدل نكس سرطان المثانة في المرحلة T1

الملخص EN

Background& Objective: The standard treatment for superficial TCC of the bladder is the endoscopic resection of all visible tumours.

Transurethral resection (TUR) may fail to control superficial disease, especially in patients with higher tumour stages (T1), in addition to the high recurrence rate.

To evaluate the role of a second transurethral resection (early re-resection) in reducing the high recurrence rate of T1 bladder tumours .

Materials & Methods: Between 2009 and 2012, 260 T1 bladder cancer patients were prospectively randomised to two groups, Second TUR was performed within 4–6 weeks after the initial resection for the patients of group 1.The pathologic records of the second TUR were reviewed and compared with the findings of the first operation.

The evaluation included the presence residual tumors, changes to histopathological staging.

Recurrence rate of the two groups were compared.

Follow-up cystoscopy were performed at 3-mo intervals for the first year.

SPSS software was used for statistical analysis.

Results: The patient and tumor characteristics were analysed without a significant difference between the groups.

Residual tumour was detected histopathologically in 55 (40.44%) of 136 patients in group 1.

Of these patients, 29 (21.32%) had residual tumors of the same stage (T1), 11 (8.09%) had a lower stage (Ta) and 15 (11.03%) had a higher stage (pT2)( up-staging).

In 87.27% of the cases, residual tumors were located at the initial site.

Recurrence rate was 18.38% in group 1 and 39.52% in group 2.

Median recurrence-free survival was 11 mo for group 1 compared with 6 mo for group 2.

Thr role of re-TURBT in reducing recurrence rate was more important in case of high grade, bigger size (>3cm), and multifocality of the T1 tumors at the initial resection .

Conclusions: Second TUR has significantly decreased the recurrence rate in patients with T1 disease compared to patients with T1 disease but with no second TUR.

So a routine re-TURBT should be advised in high grade, large size (>3 cm) and/or multifocal (T1) patients in order to achieve a better disease control and reduce recurrence rate