Bladder cancer (BC) is considered one of the malignancies with moderate-high incidence, high rate of recurrence and costly management. Diagnosis and staging are thus important for therapeutic purposes. Considering the risk of residual tumour and understaging, in specific cases, international guidelines recommend performing a second transurethral resection of the bladder (reTURB). Our study aimed to evaluate the impact of hexaminolevulinate Photodynamic Diagnostics (PDD) at first TURB on the rate of residual tumour.
We retrospectively analysed patients undergoing TURB in our centre between 2012 and 2020. Eightytwo patients had a re-TURB after a first complete TURB with a delay < 3 months. Patients who had an incomplete first resection were excluded. We compared patients who underwent standard white light cystoscopy/TURB and then hexaminolevulinate PDDguided reTURB (group A, n = 49) and patients with PDD-cystoscopy/ TURB at the first procedure then white light cystoscopy/reTURB (group B, n = 33). The residual tumour rate at reTURB as well as median recurrence-free survival (RFS) were compared between the two groups.
Residual tumour at reTURB was detected in 48.8% of cases in our cohort, with a significant difference between the two groups (71.4% in group A versus 12.5% in group B, p < 0.001). After a median follow-up of 22 months, the median RFS was 15 months in Group A and 32 months in Group B, but this difference was not significant (p = 0.7).
Using PDD at the time of the initial TURB had a statistically significant impact on the rate of residual tumour at the reTURB. Nevertheless, the percentage of residual tumour even with the use of PDD does not allow for safely omitting second resection. Performing a reTURB with PDD for patients who did not have it initially, provides the same benefit in terms of recurrence-free survival.
Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica. 2022 Dec 27*** epublish ***
Vito Lorusso, Laure Doisy, Antonio Maria Granata, Andrea Gregori, Celeste Manfredi, Lorenzo Spirito, Carmine Sciorio, Luca Giuseppe Maria Ciancimino, Samuele Molteni, Michele Morelli, Luigi Cirillo, Luigi Napolitano, Jochen Walz, Geraldine Pignot
Department of Urology, Institut Paoli-Calmettes Cancer Center, Marseille, France; Department of Urology, ASST Fatebenefratelli-Sacco Hospital, Milan, Italy; University of Milan. ., Department of Urology, Institut Paoli-Calmettes Cancer Center, Marseille. ., Department of Urology, ASST Fatebenefratelli-Sacco Hospital, Milan. ., Department of Urology, ASST Fatebenefratelli-Sacco Hospital, Milan. ., Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples. ., Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples. ., Department of Urology, ASST Lecco, Ospedale Alessandro Manzoni, Lecco. ., Department of Urology, ASST Lecco, Ospedale Alessandro Manzoni, Lecco. ., Department of Urology, ASST Lecco, Ospedale Alessandro Manzoni, Lecco. ., Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan. ., Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples. ., Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples. ., Department of Urology, Institut Paoli-Calmettes Cancer Center, Marseille. ., Department of Urology, Institut Paoli-Calmettes Cancer Center, Marseille. .