Objective. To improve the results of surgical treatment of non-muscle invasive forms of bladder cancer using a new method of en-bloc transurethral resection.
Materials and methods. The method is based on using impulses of high-frequency current applied to the active electrode of the resectoscope. The impulse sequence and individual impulse duration within the interval from 0.1 to 1 second are controlled in the course of the operation. In practice, use of the impulse mode of the resection makes it possible to bloodlessly and safely dissect the bladder wall within the target layer, reliably orientate in the anatomy of the organ tissues, radically en-bloc remove single and multiple bladder tumors of any location and size including those located in the area of the ureteral orifices. The long-term results of surgical treatment of 136 patients (96 male and 40 female) with non-muscular invasive bladder cancer were analyzed in this study. The median age of the patients operated on using the new method was 60.5 [53.00; 70.75] years. The average size of the removed tumors was 2.85±0.11 cm while the median was 2.9 [2.0; 3.5] cm. Single tumors were removed in 97 (71.3%) patients and multiple ones — in 39 (28.7%) patients. The ureter orifices involved in the tumor growth were resected in 30 (22.05%) patients. The median observation time in the en-bloc transurethral resection group was 69.5 [50.25; 99.75] months.
Results. There were no perioperative complications and no cases of conversion to the standard TURBT. During the follow-up period, tumor recurrences occurred in 48 (35.3%) patients and only in 7 (5.4%) patients — in the site of the primary tumor localization, namely, in the edge of the postoperative scar. The average follow-up period before the recurrence was 25.72±3.22 months, the median — 17.5 [11.00; 34.25] months. The 1-, 3- and 5-year recurrence-free survival rates were 88.2±2.8%, 69.9±4.1% and 62.1±5%, respectively. The average time passed before the progression was 47.5±12.34 months, the median — 53.50 [21.75; 67.25] months. The 1-, 3- and 5-year survival rates before the progression were 100%, 99.3±0.7%, and 97.2±1.6%, respectively; the 1-, 3- and 5-year cancer-specific survival was 100% on the first year of the follow-up and 99.20.8% during 3- and 5-year follow-up periods.
Conclusion. This research confirms that the proposed method of en-bloc transurethral resection for non-muscle invasive bladder cancer adhering to the principles of oncological surgery, unlike the known analogues, does not require use of additional equipment, reduces the risk of perioperative complications, is applicable in all cases regardless of the tumor location in the bladder lumen, its size, vascularization, and growth pattern. In addition, it improves significantly the immediate and long-term cancer treatment results.Ключевые слова:
Автор(ы): I. L. Masanski, S. A. Krasny