İkinci Transüretral Rezeksiyonun Yüzeyel Mesane Kanserli Hastalardaki Değeri

Year 2006, Volume: 39 Issue: 2, 108 - 111, 01.08.2006

Fatih Hızlı Yurdaer Kaynak Emine Benzer Ferhat Berkmen

Abstract

Transurethral tumor resection (TUR) is the first treatment step in bladder cancer. İt is a diagnostic, prognostic and also the-rapeutic procedure. Ali further treatment decisions, if any, are based on the results of the TUR. However, the histologic diagnosis may be compromised by fulguration of the surgical specimen or by incomplete resection of the tumor and this increases the risk of early recurrence and progression. Therefore some investigators suggest second TUR routinely in ali cases of superficial bladder cancer. However, the role of second TUR is stili controversial. The objective of this study was to evaluate the value of second TUR in patients vvith superficial bladder cancer. From January 2004 to January 2005 a total of 20 patients vvith superficial bladder cancer (stage Ta and Tl) undervvent second TUR in our clinic. Ali second TUR were video assisted and 26 F 30° optic Kari Storz™ resectoscopes were used. Firstly the visible tumor was resected, also resection of tumor margin and tumor base to the dee-per muscle layer were performed. Subsequent operations were performed vvithin 2 to 6 weeks. The histopathologic reports of the first and second TUR specimens of ati patients included in our study were revievved. The rate of residual tumor tissue after the initial resection was determined and correlated vvith the tumor characteristics and histologic findings during the first operation. No operative com-plication was visualized. Of the 20 patients 3 (15%) were female, 17 (85%) male. The mean age of femaie and male patients were 61.7 and 59.6, respectively. 55% of patients were in stage Ta and 45% in stage T1. Divided by grade, 6 (30%) patients had grade 1, 14 (70%) had grade 2 tumor. Nine patients had unifocal, 11 had multifocal tumor. Second TUR 2-6 vveeks later showed persisting carcinoma in 7 of 20 patients. Of these 7 patients 5 had Ta, 2 had T1 tumor. No upstaging was observed in any patients. Persisting tumor found at second TUR was independent of patient's age and sex, but most of patients vvith residual tumor (86%) had multifocal disease. Retrospective studies have shown that second TUR some weeks later stili revealed tumor in 30% to 70% of patients and 80% ıvere found on the initial localisation. Also surgeon's experience was found to have no effect on the rate of tumor detected at the second TUR. Significant proportion of superficial bladder cancer recurrences might be due to high rate of tumor left behind. Second TUR may be useful as it provides a better evaluation of clinical stage and seeks out residual tumor. Also it may provide better long-term recurrence free survival and may decrease the need for radical cystectomy. İn the light of our data and literatüre, second TUR is a saf e procedure vvith low morbidity and virtually no complication, so should beco-me a routine procedure in patients vvith superficial bladder cancer. To evaluate the true impact of second TUR, larger prospecti-ve randomized trials should be conducted.

Keywords

Bladder tumor, superficial, treatment, second transurethral resection.

The Value of A Second Transurethral Resection in Patients with Superficial Bladder Cancer

Abstract

Mesane tümörünün sık tekrarlamasının bir nedeni de, TUR sonrası rezidü tümör oranının yüksek olması olabilir. Bu nedenle bazı otörler tüm yüzeyel mesane tümörlü hastalara ikinci TUR önermektedir. Fakat ikinci TUR'un yüzeyel mesane kanserindeki yeri hala tartışmalıdır. Bu çalışmada yüzeyel mesane tümörlü hastalarda ikinci TUR'un yeri araştırıldı. Ocak 2004-Ocak 2005 tarihleri arasında mesane tümörü nedeni ile hastanemiz üroloji kliniğine başvuran, daha önce bir veya birkaç kez öpere edilmiş ve ikinci mesane tümörü rezeksiyonunu kabul eden 20 hasta çalışmaya dahil edildi. Çalışmaya dahil edilen tüm hastalara ilk rezeksiyonlarından iki-altı hafta sonra ikinci bir rezeksiyon uygulandı. İkinci tümör rezeksiyonunun histopatolojik sonuçları son rezeksiyon sonuçları ile rezidü tümör varlığı, tümör evre ve grade değişimine, tedavi ve takipte değişime yol açıp açmadığı açısından karşılaştırıldı. Çalışmaya dahil edilen 20 hastanın 3 (%15)'ü kadın, 17 (%85)'si erkekti. Kadın hastaların ortalama yaşı 61.7 (55-68), erkek hastaların 59.6 (29-71) idi. Hastalara yapılan ikinci rezeksiyon sonucunda 7 (%35) hastada rezidü tümör saptanmıştır. Bunların 5 (%25)'i Ta, 2 (%10)'si T1 idi. Sonuç olarak yüzeyel mesane tümörlerindeki sık rekürrens oranının bir nedeni de yetersiz cerrahi olabilir, ikinci TUR'un, gözden kaçmış tümör yayılımının erken saptanmasına ve tedavisine olanak sağlayarak, sistektomi ihtiyacını azaltacağı ve sağkalım üzerine olumlu etkileri olacağı kanaatindeyiz.

Keywords

Mesane tümörü, yüzeyel, tedavi, ikinci transüretral rezeksiyon.

References

• Hail FIR. Transurethral resection for transitional celi carcino- ma. Problems in Urology 1992;6:460-70.
• Solovvay MS, Kurth KH, Herr H, et al. Surgical techniçues in the management of patients with superficial bladder cancer. İn: Deniş L, Niijima T, Prout G, Schröder FH (eds). Development in Bladder Cancer. Prog d in Biol Res 1986;221:123-32.
• Milner WA. Results in the treatment of bladder tumors. J Urol 1953;69:657-64.
• Marberger H, Marberger M, Decristofero A. The current sta­ tus of transurethral resection in the diagnosis and theraphy of carcinoma of the urinary bladder. Int Urol Nephrol 1972;4:35-44.
• Klan R, Loy V, Huland H. Residual tumor discovered in rou- tine second transurethral resection in patients with stage T 1 transitional celi carcinoma of the bladder. J Urol 1991;146:316-8.
• Köhrmann KU, Woeste M, Kappes J, et al. Der Wert der transurethralen Nachresektion beim Harnblasenkarzinom. Akt Urol 1994;25:208. oberflachlichen
• Mersdorf A, BrauersA, VVolffJM, et al. 2nd TUR for superfi­ cial bladder cancer: A must? J Urol Suppl 1998;159:143.
• Herr HW. The value of a second transurethral resection in evaluating patients with bladder tumors. J Urol 1999;162:74-6.
• Vögeli TA, Grimm MO, Ackermann R. Prospective study for
• quality control of TUR of bladder tumors by routine 2Fd TUR (ReTUR). J Urol 1998:159:143.
• Vögeli TA, Grimm MO, Simon X, et al. Prospective study to assess repeat transurethral resection in superficial bladder cancer. Urologe 2002;41:470-4.
• Zurkirchen MA, Sulser T, Gaspert A, et al. Second transurethral resection of superficial transitional celi carci­ noma of the bladder: A must even for experienced urolo- gists. Urol Int 2004;72:99-102.
• Grimm MO, Steinhoff C, Simon X, et al. Effect of routine repeat transurethral resection for superficial bladder cancer: A long-term observational study. J Urol 2003;170:433-7.
• Jakse G, Algaba F, Malmström PU, et al. A second-look TUR in T1 transitional celi carcinoma: Why? Eur Urol 2004;45:539-46.
• Miladi M, Peyromaure M, Zerbib M, et al. The value of a second transurethral resection in evaluating patients with bladder tumors. Eur Urol 2003;43:241-5.
• Bressel M, Kemper K, Stadler. Vorbedingungen und Technik der transurethralen Harnblasenkarzinoms. Urologe 1969;8:73-80.
• Elektroresektion des
• Birch BRP, Harland SJ. The PT1G3 bladder tumour. Br J Urol 1989;64:109-16.
• Jewett MAS, Larsson PCM. Appropriate restaging biopsies after initial resection or topical intravesical theraphy. Atlas Urol Clin N Am 1997;5:15-22.