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Can We Perform Frozen Section Instead of Repeat Transurethral Resection in Bladder Cancer? - Beyond the Abstract

The crucial role of transurethral resection of bladder tumor (TURBT) in nonmuscle-invasive bladder cancer (NMIBC) is to correctly diagnose and completely remove all visible tumoral lesions. It is a crucial step in the management of the NMIBC, and it should be performed systematically.1 Performing a qualified TURBT includes obtaining sufficient tissue to determine the histological type and grade of the tumor, obtaining muscle tissue to assess tumor depth and stage, and removing all tumoral tissues including the surrounding healthy areas.2 On the other hand, inadequate TURBT leads to a misstaged and delayed treatment, resulting in worse treatment outcomes.3 Therefore, a repeat transurethral resection (reTUR) procedure is necessary for some situations.


In our published study, we aimed to compare the additional frozen section (FS) method performed at the end of the permanent section (PS) during the first TURBT procedure with the reTUR section (RS) procedure to reduce the need for a second resection. Thus, it was also aimed to improve muscularis propria (MP) sampling and the quality of the first TURBT and reduce waste of time for definitive treatment of muscle-invasive bladder cancer in the study.4

The most recurred area is the tumor basis in the evaluation of RS. Therefore we performed an additional deep resection on tumor basis for FS when the surgeon had finished resection of the first TURBT. After the pathological examination of FS by a uropathologist, the TURBT procedure was ended. ReTUR procedure was performed for all patients.4

After the pathological examination of all tissues, no statistical significance difference between FS and RS sampling methods (p=0.603) was discovered. The detecting residual tumor rates were found to be similar.4

Our findings show us that especially in patients with detected residual tumors after the pathological examination of FS during the procedure, re-resection can be a choice at the end of the first TURBT instead of reTUR. This way we can reduce the need for reTUR as well as improve outcomes of the first TURBT. In addition, we may protect the patients from one more operation which can cause more costs and possible side effects.

Written by: Doğan M Değer, MD, Department of Urology, Dokuz Eylül University, School of Medicine, İzmir, Turkey; Serdar Çelik, MD, PhD, Department of Basic Oncology, Dokuz Eylül University, Institute of Oncology, İzmir, Turkey; Güven Aslan, MD, Department of Urology, Dokuz Eylül University, School of Medicine, İzmir, Turkey.

References:

  1. Babjuk, Marko, Maximilian Burger, Eva M. Compérat, Paolo Gontero, A. Hugh Mostafid, Joan Palou, Bas WG van Rhijn et al. "European association of urology guidelines on non-muscle-invasive bladder cancer (TaT1 and carcinoma in situ)-2019 update." European urology 76, no. 5 (2019): 639-657.
  2. Qie, Yunkai, Hailong Hu, Dawei Tian, Yu Zhang, Linguo Xie, Yong Xu, and Changli Wu. "The value of extensive transurethral resection in the diagnosis and treatment of nonmuscle invasive bladder cancer with respect to recurrence at the first follow-up cystoscopy." OncoTargets and therapy 9 (2016): 2019.
  3. Capogrosso, Paolo, Umberto Capitanio, Eugenio Ventimiglia, Luca Boeri, Alberto Briganti, Renzo Colombo, Francesco Montorsi, and Andrea Salonia. "Detrusor muscle in TUR-derived bladder tumor specimens: can we actually improve the surgical quality?." Journal of Endourology 30, no. 4 (2016): 400-405.
  4. Değer, Müslim Doğan, Serdar Çelik, Alperen Yıldız, Hilmi Sarı, Batuhan Yılmaz, Ozan Bozkurt, Burçin Tuna, Kutsal Yörükoğlu, and Güven Aslan. "Can we perform frozen section instead of repeat transurethral resection in bladder cancer?." In Urologic Oncology: Seminars and Original Investigations. Elsevier, 2020.
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