En bloc re-resection of high-risk NMIBC after en bloc resection: results of a multicenter observational study.

To investigate the role of en bloc re-resection (EBRS) in patients who had undergone previous en bloc resection for high-risk non-muscle-invasive bladder cancer (NMIBC).

An international, multicenter, observational retrospective analysis of prospectively collected data. Patients with a high-risk NMIBC who had previously undergone en bloc resection were scheduled for EBRS of the resected area after 40 days. The primary outcome was the presence of residual tumor or recurrence-free survival.

Overall, 78 patients underwent EBRS. Only five (6.41%) residual cancers were found: one patient had a pTa G3 (1.28%) cancer and four (5.13%) had a pTis. The detrusor muscle was preserved in all samples. Only one patient had a positive margin on EBRS. No procedure called for a conversion to traditional re-TURBT. No patient experienced bladder perforation or other intra-operative complications. The recurrence rate at the first follow-up cystoscopy (RRFF-C at 3 months) was 3.85% (three patients). The median follow-up period was 30.8 months (range 6.9-76.0 months). In univariate analysis, the only predictor of recurrence was grade. Overall we observed 11 recurrences. Only one tumor progressed to T2 MIBC.

The low rates of residual tumor, recurrence, and progression seem to raise doubts about the efficacy of EBRS in patients who have previously undergone en bloc resection. EBRS appears to be a feasible and safe procedure with a low rate of complications. However, further data will be needed before EBRS can be used in clinical trials or recommended as a treatment modality.

World journal of urology. 2019 May 21 [Epub ahead of print]

Rodolfo Hurle, Paolo Casale, Massimo Lazzeri, Marco Paciotti, Alberto Saita, Piergiuseppe Colombo, Emanuela Morenghi, David Oswald, Daniela Colleselli, Michael Mitterberger, Thomas Kunit, Martina Hager, Thomas R W Herrmann, Lukas Lusuardi

Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy., Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy. ., Department of Pathology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy., Department of Biomedical Science, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy., Department of Urology, Paracelsus Medical University, Salzburg, Austria., Department of Pathology, Paracelsus Medical University, Salzburg, Austria., Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland.