Herrmann Thomas R W, Wolters Mathias, Kramer Mario W
aSection of Endourology, Laparoscopy and Robotics, Department of Urology and Urologic Oncology, Hanover Medical School, Hanover, Lower Saxony bEBRUC En Bloc Resection of Urothelial Cancer Consortium cDepartment of Urology, Campus Luebeck, University Clinic of Schleswig-Holstein, Luebeck, Schleswig-Holstein, Germany.
Curr Opin Urol. 2017 Mar;27(2):182-190. doi: 10.1097/MOU.0000000000000377.
Inherent limitations of conventional transurethral resection of bladder tumors as the standard approach for diagnosis and treatment of bladder cancer are well know: staging error because of insufficient assessment of resection depth as well as intravesical tumor fragmentation that complicates histopathological evaluation. The purpose of this review is to present recent clinical data on en bloc resection of bladder tumor (ERBT) that has been demonstrated to offer high potential to overcome these limitations.
The recently published studies confirm the results our previous reviews for laser ERBT and current-based ERBT from 2014. ERBT provides a better resection quality with up to 95% presence lamina muscularis propria as surrogate marker for quality. It can be performed using all energy sources. Available data demonstrate with all due limitations of reporting quality no relevant difference with regard to perioperative morbidity compared with conventional transurethral resection of bladder tumors. No conclusions can be drawn regarding the impact of ERBT on recurrence as data are controversial.
ERBT has gained momentum in the past years. The hypothesized advantages over conventional TURBT seem to manifestate for tumors up to 3 or 4 cm in size with regard to staging, specimen quality, and analyzability in pathological evaluation in general. The impact on recurrence remains to be defined by further studies.
传统经尿道膀胱肿瘤切除术作为膀胱癌诊断和治疗的标准方法，其固有的局限性是众所周知的：由于对切除深度评估不足导致分期错误，以及膀胱内肿瘤破碎，使组织病理学评估变得复杂。本综述的目的是介绍关于整块切除膀胱肿瘤（ERBT）的最新临床数据，已证明其具有克服这些局限性的巨大潜力。
最近发表的研究证实了我们之前对2014年激光ERBT和基于电流的ERBT的综述结果。ERBT提供了更好的切除质量，以高达95%的肌层固有层存在作为质量替代指标。它可以使用所有能量源进行。现有数据表明，尽管报告质量存在各种局限性，但与传统经尿道膀胱肿瘤切除术相比，围手术期发病率无显著差异。由于数据存在争议，无法就ERBT对复发的影响得出结论。
在过去几年中，ERBT发展势头迅猛。对于一般大小达3或4厘米的肿瘤，ERBT在分期、标本质量和病理评估的可分析性方面，相对于传统经尿道膀胱肿瘤切除术的假设优势似乎得以体现。其对复发的影响仍有待进一步研究确定。
