Feasibility study of transurethral en-bloc resection of bladder tumor under electronic flexible cystoscopy combined with adjuvant therapy for bladder-preservation-therapy in T 2 stage bladder cancer
10.3760/cma.j.cn112330-20221229-00686
- VernacularTitle:电子膀胱软镜下膀胱肿瘤整块切除术联合辅助治疗对T 2期膀胱癌保膀胱综合治疗的可行性
- Author:
Qi WANG
1
;
Hongliang YU
;
Yi WANG
;
Jinyou WANG
;
Chao YANG
;
Xin CHEN
;
Zhiqi LIU
;
Wei SUN
;
Lu FANG
;
Dexin YU
;
Jie MIN
Author Information
1. 安徽医科大学第二附属医院泌尿外科，合肥 230601
- Keywords:
Narrow band imaging flexible cystoscopy;
En-bloc resection of bladder tumor;
Adjuvant therapy;
Bladder-preservation-therapy
- From:
Chinese Journal of Urology
2023;44(12):901-905
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the feasibility of combination of en-bloc resection of bladder tumor (ERBT) with the NBI(narrow band imaging) flexible cystoscopy, immunotherapy and chemotherapy in bladder-preserving treatments(called as TMT) for patients with stage T 2 bladder carcinoma. Methods:We retrospectively reviewed and analyzed a series of 16 patients with pT 2N 0M 0 pathologically confirmed. All patients are male with a median age of 63yr(56, 73yr). The American Association of Anesthesiologists scored ≤Ⅱ in 12 cases and Ⅲ in 4 cases. There were 9 cases with smoking history, 5 cases with hypertension, 3 cases with diabetes, and 2 cases with heart disease. The results of preoperative tissue biopsy were all urothelial carcinoma. All patients were taken lithotomy position and performed ERBT with NBI imaging technique and thulium-laser energy platform under general anesthesia. The tumor was brown and the surrounding normal mucosa was cyan in color. The procedure was ensured with a minimal tumor margin of 1cm and minimal rection depth to the deep musculi, and with the acquirement for the en-bloc specimen of which the basal site was marked afterwards, the patients all took a full length of chemoimmunotherapy (four cycles of Tislelizumab combined with Gemcitabine and cisplatin regimens) followed by a secondary ERBT. The perioperative data from sequential operations including complications were comprehensively analyzed for evaluating the therapeutic outcome and safety. All patients received a follow-up to detect efficacy and safety of the treatment with the primary end point of pCR, downgrading rate and objective response rate. Results:All operations were successfully completed. There was no obturator reflex, severe bleeding or grade Ⅱ bladder perforation, only 4 patients got a grade Ⅰ bladder perforation. The postoperative 30-day complication occured in 2 cases(1 pt with hematuresis, 1 pt with bladder irritation). The pathologic complete response rate and tumor downstaging rate were 100%. One patient recurred during a median follow-up of 13.0 months (6, 36 months).Conclusions:The En Bloc Resection of Bladder Tumor with the narrow band imaging (NBI) flexible cystoscopy has several remarkable advantages, including a better intra-operative visual, a lower complication rate and tumor residual. The combination of ERBT with immunotherapy and chemotherapy lead to affirmative curative effect and the feasibility for clinical application is relatively high.
