Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy.
Curr Opin Urol. 2020 May;30(3):370-376. doi: 10.1097/MOU.0000000000000751.
To summarize the current knowledge on the role of repeated transurethral resection of the bladder (re-TURBT) at the light of recently published trials that indicate the possibility to safely avoid it in well selected patients.
Recently published trials tried to predict the histology of re-TURBT with the aim of improving patients' selection for this procedure. The en bloc resection technique seems to improve the quality of the resection, thereby diminishing and even eliminating the risk of upstaging and the residual disease rate after TURBT. Moreover, the introduction of multiparametric MRI (mpMRI) in bladder cancer showed initial promising results and aims, in the next future, to play a role in the selection of patients for re-TURBT.
International guidelines agree to recommend re-TURBT in case of incomplete first resection and in T1 tumors. Conversely, the performance of re-TURBT in case of high-grade/high-risk Ta or in case of absence of detrusor muscle in TURBT specimen remains a matter of debate. Re-TURBT aims to reduce the risk of understaging the disease and to remove residual disease in case of persistent nonmuscle invasive bladder cancer. Actually, upstaging at re-TURBT is not a negligible event in T1 tumors (8-15%), while is quite uncommon in case of Ta tumors (0.4%). Residual disease at re-TURBT is usually found in the majority of patients (55-60%) and seems to impact oncological outcomes, even if recent evidence mitigated its relevance as prognostic factor.
根据最近发表的试验结果，总结目前关于重复经尿道膀胱肿瘤切除术（re-TURBT）作用的认识，这些试验表明在选择合适的患者时可以安全地避免该手术。
最近发表的试验试图通过预测 re-TURBT 的组织学来改善患者对该手术的选择。整块切除技术似乎可以提高切除质量，从而降低甚至消除 TURBT 后分期升级和残留疾病的风险。此外，膀胱癌多参数 MRI（mpMRI）的引入显示出初步的有前景的结果，有望在未来在选择 re-TURBT 患者方面发挥作用。
国际指南一致建议在初次切除不完全和 T1 肿瘤的情况下进行 re-TURBT。相反，在高级/高危 Ta 或 TURBT 标本中缺乏逼尿肌的情况下进行 re-TURBT 的性能仍然存在争议。re-TURBT 的目的是降低疾病分期不足的风险，并在持续存在非肌肉浸润性膀胱癌的情况下清除残留疾病。实际上，在 T1 肿瘤中 re-TURBT 分期升级并不是一个可以忽略的事件（8-15%），而在 Ta 肿瘤中则相当罕见（0.4%）。re-TURBT 后的残留疾病通常在大多数患者中发现（55-60%），并且似乎对肿瘤学结果有影响，尽管最近的证据减轻了其作为预后因素的重要性。
