Poletajew Sławomir, Krajewski Wojciech, Stelmach Paweł, Adamowicz Jan, Nowak Łukasz, Moschini Marco, Zapała Piotr, Drewa Tomasz, Paradysz Andrzej, Radziszewski Piotr, Zdrojowy Romuald, Kryst Piotr
Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland.
Department of Urology and Oncological Urology, Wroclaw Medical University, Wroclaw, Poland.
Wideochir Inne Tech Maloinwazyjne. 2021 Mar;16(1):145-150. doi: 10.5114/wiitm.2020.95399. Epub 2020 May 15.
Transurethral resection of bladder tumour (TURBT) is one of the most commonly performed urologic procedures. Because of the shortcomings of conventional TURBT, the en-bloc resection concept was created.
To analyse the influence of en-bloc technique on surgical and oncological outcomes of TURBT performed with electric current.
This non-randomized, prospective controlled multicentre study enrolled 427 consecutive patients undergoing TURBT performed by five experienced endourologists in five academic institutions. Choice of procedure was at the discretion of the surgeon. The vast majority of patients underwent monopolar resection. The en-bloc procedure was performed with Collin's knife or the classic resection loop. Study end-points were surgery, catheterization and hospitalization time, presence of muscularis propria (MP) in the specimen and 3-month recurrence-free survival (RFS).
The study included 427 (274 conventional TURBT vs. 153 en-bloc) patients with mean age of 69 years (range: 18-99). There were more cases with MP present in the specimen in the en-bloc group (91.3% vs. 75.5%; p < 0.001). Surgery and hospitalization times were statistically shorter in the en-bloc group (both p < 0.05). A borderline significant difference was noted when the number of residual tumours in reTURBTs was analysed, with fewer cases of residual tumour in the en-bloc group (p = 0.051). RFS at 3 months was higher in the en-bloc group (88.4% vs. 80.1%; p = 0.027). After propensity score matching, differences in MP presence, hospitalization time and 3-month RFS status remained statistically significant.
When compared to conventional TURBT, en-bloc resection of bladder tumour is associated with higher percentage of MP presence in histopathological specimen, higher 3-month RFS and shorter hospitalization time.
经尿道膀胱肿瘤切除术（TURBT）是最常施行的泌尿外科手术之一。由于传统TURBT存在不足，整块切除的概念应运而生。
分析整块切除技术对经电流进行的TURBT手术及肿瘤学结局的影响。
这项非随机、前瞻性对照多中心研究纳入了由五家学术机构的五位经验丰富的腔内泌尿外科医生连续进行TURBT手术的427例患者。手术方式由外科医生自行决定。绝大多数患者接受单极切除术。整块切除手术采用柯林氏刀或经典切除环进行。研究终点包括手术、导尿及住院时间、标本中肌层固有层（MP）的存在情况以及3个月无复发生存率（RFS）。
该研究纳入了427例患者（274例行传统TURBT，153例行整块切除），平均年龄69岁（范围：18 - 99岁）。整块切除组标本中存在MP的病例更多（91.3%对75.5%；p < 0.001）。整块切除组的手术和住院时间在统计学上更短（均p < 0.05）。在分析再次TURBT时残余肿瘤数量时发现有临界显著差异，整块切除组的残余肿瘤病例较少（p = 0.051）。整块切除组3个月时的RFS更高（88.4%对80.1%；p = 0.027）。在进行倾向得分匹配后，MP存在情况、住院时间和3个月RFS状态的差异在统计学上仍具有显著性。
与传统TURBT相比，膀胱肿瘤整块切除术在组织病理学标本中MP存在比例更高、3个月RFS更高且住院时间更短。
