A More Thorough Transurethral Resection

نویسنده

  • Edward M. Messing
چکیده

The standard initial treatment for urothelial cancer and other tumors of the bladder is a complete transurethral resection (TURBT). This is, of course, also a diagnostic and staging procedure and the information gained from both the endoscopic and histologic examinations have huge prognostic and management implications. But the hallmark of this procedure, particularly for non-muscle invading (NMI) urothelial cancers (UCs) is that all VISIBLE tumor is resected/ablated. With rare, although notable exceptions (e.g. too much tumor to safely resect at one sitting, recognized large bladder perforation early in the case, obvious deeply invasive cancer that is unresectable transurethrally, very diffuse suspected carcinoma-in-situ [CIS]) it is generally considered inappropriate to leave known tumor unsampled and untreated. The adverse clinical implications of doing this, including histological undersampling (and thus developing incorrect management plans) and requiring subsequent intravesical chemo or immunotherapeutic treatments to kill larger clumps of tumor than is optimal, can range from being unnecessarily morbid and costly for patients, to being catastrophic for them. However, since even low grade (LG) NMI UC recurs frequently and rapidly [1], the possibility of incomplete resection/ablation with a TURBT is very real, in large part because of incomplete tumor visualization. That this is the case has been demonstrated in numerous randomized studies that have utilized the two most frequently tested methods for enhanced tumor visualization: Photodynamic diagnosis (PDD) and narrow band imaging [2–6].

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عنوان ژورنال:

دوره 3  شماره 

صفحات  -

تاریخ انتشار 2017