Transurethral Endoscopic Submucosal Dissection of Bladder Tumor with Hybrid Knife – 31 cases report
Transurethral resection of bladder tumor (TURBT) is golden standard treatment for non-muscle invasive bladder cancer (NMIBC) with high recurrence ratio (33.8% - 36%). The possible reasons for high recurrence rate include tumor residual, tumor cell seeding, short of surgery experience and unidentifiable invasive depth of tumor pathology. Endoscopic submucosal dissection (ESD) using Hybrid Knife is a technique implanting from Gastroenterology. We use ESD technique to resect bladder tumor en-bloc with distinct base pathology.
31 patients with lower-grade bladder urothelial carcinoma underwent transurethral ESD using Hybrid Knife. The procedure was described below:1) Marking tumor margin. 2) Injecting water cushion. 3) Resecting tumor between submucosa and detrusor completely. 4) Inspecting wound surface. 5) Taking out specimen completely. All patients were treated with immediate single instillation with epirubicin 50mg after operation (no longer 24 hours) and followed up every three months for a year with cystoscopy.
All tumors were completely resection with 21.2% of tiny perforation (7 cases). No patients received bladder irrigation more than one day. Among of them 17 patients (61.3%) did not receive irrigation. There were no severe complications happened. After operations, all the patients were removed urinary catheters within 24 hours and discharged the next day. The results of postoperative tumor pathology indicated: 3 cases of inverted papilloma with malignant potential (9.7%), 26 cases of low-grade papillary urothelial carcinoma (83.9%), 2 cases of high-grade urothelial papillary carcinoma (6.5%). The invasion depth of tumors limited in mucosa (26 cases, 83.9%)or submucosa (5 cases, 16.1%). All the patients were followed up one year, with only 3 cases of recurrence (9.7%, 3 months, 6 months and 9 months after resection respectively).
Transurethral ESD in patients with Ta/T1 bladder tumor is feasible and effective with safe oncologic outcomes. ESD technique allows the bladder tumor to be resected completely en-bloc, avoiding the risks of TURBT, such as tumor residual, tumor cell seeding. Meanwhile ESD technique can provide the complete and distinct mucosa and submucosa to pathologists to identify tumor invasion depth.