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LASER EN-BLOC RESECTION OF NON-MUSCLE-INVASIVE BLADDER CANCER: CLINICAL AND MORPHOLOGICAL SPECIFICITIES
- Authors: Severgina L.O.1, Sorokin N.I.1, Dymov A.M.1, Tsarichenko D.G.1, Enikeev D.V.1, Kislyakov D.A.1, Rapoport L.M.1, Korovin I.A.1, Korolev D.O.1
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Affiliations:
- Sechenov First Moscow State Medical University, Ministry of Health of Russia
- Issue: Vol 14, No 3 (2018)
- Pages: 78-84
- Section: DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS. URINARY BLADDER CANCER
- Published: 30.09.2018
- URL: https://oncourology.abvpress.ru/oncur/article/view/838
- DOI: https://doi.org/10.17650/1726-9776-2018-14-3-78-84
- ID: 838
Cite item
Abstract
Objectives to enhance the morphological diagnostic complex in order to predict postoperative outcomes in a more accurate way and to optimize patients with non-muscular invasive bladder cancer treatment.
Materials and methods. The study included 34 patients from 25 to 71 years old underwent laser en-block resection, the most of them were males – 28. In 9 cases multiple carcinomas (2 or more) were found. Huge tumors (2 cm or more in one dimension) were resected in 6 patients. Results. The major part of tumors removed (n = 22) histologically appeared to be papillary urothelial carcinomas with low grade of malignancy and PUNLMP; in 6 cases G2 was verified, one tumor with high malignancy potention – G3. In 3 patients intramuscular invasion was found (invasive carcinoma T2) excluding them from the study.
Discussion. Laser en-block resection of non-muscle-invasive bladder cancer appears to be the most optimal approach in operative treatment that provides representative histological material. For correct morphological estimate we recommend either to expand the resection zone to 1 cm which allows to remove circular resection margin or to take extra pinch biopsy from tumor crater (vertical margin). In 3 patients from our study positive circular margin was revealed histologically whereas foci of perineural and perivascular invasion were found in one case. A new subgrading of stage T1 depending on intramuscular invasion depth was suggested whereas the main criteria is the muscularis mucosae involvement.
Conclusion. Morphological estimate of circular resection margin provides an ability to predict postoperative outcomes and correct the treatment in one or another way. Subgrading for T1-stage tumors is recommended for following correct postoperative prognosis and possibility of tumor recurrence.
About the authors
L. O. Severgina
Sechenov First Moscow State Medical University, Ministry of Health of Russia
Author for correspondence.
Email: losevergina@gmail.com
ORCID iD: 0000-0002-4393-8707
Build. 2, 8 Trubetskaya St., Moscow 119991.
Russian FederationN. I. Sorokin
Sechenov First Moscow State Medical University, Ministry of Health of Russia
ORCID iD: 0000-0001-9466-7567
Build. 2, 8 Trubetskaya St., Moscow 119991.
Russian FederationA. M. Dymov
Sechenov First Moscow State Medical University, Ministry of Health of Russia
ORCID iD: 0000-0001-6513-9888
Build. 2, 8 Trubetskaya St., Moscow 119991.
Russian FederationD. G. Tsarichenko
Sechenov First Moscow State Medical University, Ministry of Health of Russia
Build. 2, 8 Trubetskaya St., Moscow 119991.
Russian FederationD. V. Enikeev
Sechenov First Moscow State Medical University, Ministry of Health of Russia
ORCID iD: 0000-0001-7169-2209
Build. 2, 8 Trubetskaya St., Moscow 119991.
Russian FederationD. A. Kislyakov
Sechenov First Moscow State Medical University, Ministry of Health of Russia
ORCID iD: 0000-0002-7381-7084
Build. 2, 8 Trubetskaya St., Moscow 119991.
Russian FederationL. M. Rapoport
Sechenov First Moscow State Medical University, Ministry of Health of Russia
ORCID iD: 0000-0001-7787-1240
Build. 2, 8 Trubetskaya St., Moscow 119991.
Russian FederationI. A. Korovin
Sechenov First Moscow State Medical University, Ministry of Health of Russia
ORCID iD: 0000-0003-4009-346X
Build. 2, 8 Trubetskaya St., Moscow 119991.
Russian FederationD. O. Korolev
Sechenov First Moscow State Medical University, Ministry of Health of Russia
Build. 2, 8 Trubetskaya St., Moscow 119991.
Russian FederationReferences
- EAU Guidelines on Non-muscle-invasive Bladder Cancer (Ta, T1 and CIS). European Association of Urology. Guidelines 2017. Pp. 4–40.
- Bryan R.T., Collins S.I., Daykin M.C. et al. Mechanisms of recurrence of Ta/T1 bladder cancer. Ann R Coll Surg Engl 2010;92(6):519–524. doi: 10.1308/003588410X12664192076935. PMID: 20522307.
- Wu Y.P., Lin T.T., Chen S.H. et al. Comparison of the efficacy and feasibility of en bloc transurethral resection of bladder tumor versus conventional transurethral resection of bladder tumor a meta-analysis. Medicine (Baltimore) 2016;95(45):e5372. doi: 10.1097/MD.0000000000005372. PMID: 27828864.
- Kramer M.W., Rassweiler J.J., Klein J. et al. En bloc resection of urothelium carcinoma of the bladder (EBRUC): a European multicenter study to compare safety, efficacy, and outcome of laser and electrical en bloc transurethral resection of bladder tumor. World J Urol 2015;33(12):1937–43. doi: 10.1007/s00345-015-1568-6. PMID: 25910478.
- Kovylina M.V., Prilepskaya E.A., Tupikina N.V. et al. Grading of urothelial carcinoma of the bladder. Onkourologiya = Cаncer Urology 2017;13(2):87–95. (In Russ.). doi: 10.17650/1726-9776-2017-13-2-87-95.
- Wolters M., Kramer M.W., Becker J.U. et al. Tm:YAG laser en bloc mucosectomy for accurate staging of primary bladder cancer: early experience. World J Urol 2011;29(4):429–32. doi: 10.1007/s00345-011-0686-z. PMID: 21553277.
- Andreeva Yu.Yu., Danilova N.V., Moskvina L.V. et al. Tumors of the urinary system and male genitalia. Morphological diagnostics and genetics. Guideline for physicians. Ed. by Yu.Yu. Andreeva, G.A. Frank. Moscow: Prakticheskaya meditsina, 2012. 216 p. (In Russ.).
- Compe´rat E.M., Burger M., Gontero P. et. a l. Grading of urothelial carcinoma and the new “World Health Organisation classification of tumours of the urinary system and male genital organs 2016”. Eur Urol Focus 2018.
- Younes M., Sussman J., True L.D. The usefulness of the level of the muscularis mucosae in the staging of invasive transitional cell carcinoma of the urinary bladder. Cancer 1990;66(3):543–8. PMID: 2364365.
- van Rhijn B.W., Liu L., Vis A.N. et al. Prognostic value of molecular markers, substage and European Organisation for the Research and Treatment of cancer risk scores in primary T1 bladder cancer. BJU Int 2012;110(8):1169–76. doi: 10.1111/j.1464-410X2012.10996.x.
- van Rhijn B.W., van der Kwast T.H., Alkhateeb S.S. et. a l. A new and highly prognostic system to research T1 bladder cancer substage. Eur Urol 2012;61(2):378–84. doi: 10.1016/j.eururo.2011.10.026. PMID: 22036775.
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