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KMID : 1001020140120020054
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Journal of Urologic Oncology
2014 Volume.12 No. 2 p.54 ~ p.58
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Restaging TURB: When and How?
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Han Kyung-Sik
Hong Bum-sik
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Abstract
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Approximately 70% to 75% of patients with bladder cancer initially present at a low stage (stage 1), a category that includes carcinoma in situ (CIS, 1-10% alone as primary), tumors confined to the urothelial mucosa (Ta, 70%-80%), and those that invade only the underlying lamina propria (T1, 20%). The prognosis for patients with non-muscle invasive bladder cancer (NMIBC) is generally good, with approximately 80% to 90% of patients alive at 5 years. In contrast, muscle-invasive bladder cancer, which represents about 25% of cases, has a significantly lower relative 5-year survival rate of 17% to 66% depending on tumor stage. Thus, adequate TUR is critical not only to ensure accurate staging and guide future management options, but also to remove all tumors from the bladder. However, understaging rates of up to 40% for NMIBC have been reported based on radical cystectomy data. Moreover, absence of muscularis propria in the specimen leads to a significantly higher rate of understaging (50-78%). In these cases, restaging transurethral resection (TUR) should be performed. In addition, patients with high-grade (HG) Ta and HG T1 tumors, regardless of presence of muscle, are also strongly encouraged to undergo a restaging TUR. Restaging resection should be performed 2 to 6 weeks following initial TUR. Deep biopsies in the base and periphery of the old resection site should be performed. The goal of restaging TUR is threefold: to improve staging accuracy, resect any residual tumor, and potentially to improve the response to intravesical treatment
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KEYWORD
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Bladder, Transurethral resection, Cancer
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