Clinical impact of detrusor muscle in en bloc resection for T1 bladder cancer

被引:3
作者
Yanagisawa, Takafumi [1 ,2 ]
Sato, Shun [3 ]
Hayashida, Yasushi [4 ]
Okada, Yohei [5 ]
Fukuokaya, Wataru [1 ]
Iwatani, Kosuke [1 ]
Matsukawa, Akihiro [1 ]
Shimoda, Masayuki [3 ]
Takahashi, Hiroyuki [3 ]
Kimura, Takahiro [1 ]
Shariat, Shahrokh F. [2 ,6 ,7 ,8 ,9 ,10 ]
Miki, Jun [1 ]
机构
[1] Jikei Univ, Sch Med, Dept Urol, Tokyo, Japan
[2] Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
[3] Jikei Univ, Sch Med, Dept Pathol, Tokyo, Japan
[4] Natl Hosp Org Ureshino Med Ctr, Dept Urol, Saga, Japan
[5] Saitama Med Ctr, Dept Urol, Saitama, Japan
[6] Univ Jordan, Dept Special Surg, Div Urol, Amman, Jordan
[7] Univ Texas Southwestern Med Ctr, Dept Urol, Dallas, TX USA
[8] Charles Univ Prague, Fac Med 2, Dept Urol, Prague, Czech Republic
[9] Weill Cornell Med Coll, Dept Urol, New York, NY USA
[10] Karl Landsteiner Inst Urol & Androl, Vienna, Austria
基金
日本学术振兴会;
关键词
Non-muscle-invasive bladder cancer; T1; En bloc resection; TURBT; Detrusor muscle; Muscularis propria; TRANSURETHRAL RESECTION; TUMOR; QUALITY;
D O I
10.1016/j.urolonc.2023.08.004
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: Detrusor muscle (DM) in the resected specimen of patients with pT1 bladder cancer (BCa) is a quality-of-care criteria. We aimed to assess whether obtaining adequate DM is dependent on surgeon's experience, whether is a surrogate for resection quality, and whether the degree of DM thickness is related to postoperative outcomes in en bloc resection for bladder tumors (ERBT).Materials and Methods: We retrospectively analyzed the records of 106 pT1 high-grade BCa patients who underwent ERBT at several institutions. All specimens were reviewed by a single pathologist who assessed the presence or absence of DM and its thickness measured by a micrometer, when present. Early recurrence, defined as pathologically confirmed BCa on repeat resection or tumor recurrence at the first follow-up cystoscopy (within 3 months), was the endpoint reflective of the resection quality.Results: Of 106 patients, DM was detected in 99 (93%), and the median DM thickness was 1.8 mm. Large tumor size (>30 mm) was associated with adequate DM sampling (>1.8mm) (odds ratio [OR]: 6.10, 95% confidence intervals [CIs]: 2.08-17.9, P = 0.001), while surgeon's experience was not. DM presence and DM thickness were both not associated with early recurrence, while positive surgical margin was an independent prognosticator for early recurrence (OR: 3.38, 95% CI: 1.12-10.2, P = 0.031). Excessive DM sampling (>2.1 mm) was associated with prolonged urethral catheterization (OR: 28.8, 95% CI: 3.36-248, P = 0.002).Conclusions: In ERBT, surgeon's experience seems irrelevant to obtain DM. Resection quality relies on surgical margin status, not the degree of DM. Obtaining excessive DM incurs adverse events/unnecessary medical care. (c) 2023 Elsevier Inc. All rights reserved.
引用
收藏
页码:484.e7 / 484.e15
页数:9
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