Narrow Band Imaging Reduces Persistence of Cancer in Patients with pT1 High Grade Bladder Cancer - Beyond the Abstract

In this abstract, we evaluated the use of NBI technology when resecting margins and fundus on initial resection of the bladder. The primary objective was to evaluate the impact on the residual disease on reTURB.

A major problem in the treatment of NMIBC is the non-adherence to the Guidelines. re-TURB remains poorly performed ranging from 7 to 49% across different tertiary centers. Not performing re-TURB in patients with high grade disease exposes the patient to a worse outcome and prognosis. On the other side, in the literature, many authors agree that the major problem in NMIBC is the quality of initial resection and that many times early recurrences at three months are not true recurrences but just residual disease. Therefore, our group strongly believes that every effort should be addressed to improve the quality of the initial resection and to perform re-TURB in all those patients with high-grade disease.

The present abstract goes a little bit beyond the guidelines. A major problem in performing re-TURB is that it is time-consuming and carries a higher risk of perforation. Following the idea that the main problem is the initial resection, we designed this study to evaluate the impact of NBI technology in improving the persistence of disease at re TURB. Our persistence of disease was 12% which is an excellent result, but even more important none of the patients was upstaged on re-TURB. Given this results, we still think re-TURB is essential in the management of HG NMIBC.

What is the next step forward? The goal should always be the improvement of the initial resection. To do so it is important to adequately evaluate the role of the new methods of visualization as photodynamic diagnosis and NBI. However, another important technical aspect to explore together with this imaging modalities is the routine use of en-Bloc resection to improve staging on initial TURB. The available literature clearly shows that en-bloc resection improves persistence of disease and staging. With innovation and new technologies we strongly believe that in the next future persistence of disease can be brought to 0% if well designed clinical studies concentrate on this aspect.

The Key may already in our pocket.  

Written by: Roberto Giulianelli, Riccardo Lombardo, Nuova Villa Claudia, Rome, Italy

En-bloc TURBT ( E-TURBT) with Collins Loop: A New Endoscopic Treatment in the Bladder Tumour

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