COLLINS LOOP EN BLOC RESECTION( CLEBR) FOR ACCURATE STAGING OF PRIMARY NON MUSCLE INVASIVE BLADDER CANCER: EARLY EXPERIENCE
Introduction
A primary aim of transurethral resection of bladder tumors is to determine the depth of invasion or clinical stage. Transurethral resection is a stochastic procedure subject to variations in tumor type, surgical technique and pathological evaluation.
Exact pathological staging of bladder cancer is crucial for determination of further treatment. One limiting factor is the surgical ‘incise and scatter’ technique that might contribute to tumour recurrence.
We present initial results with using a Collins loop (with a cutting current) en bloc resection ( CLebR) of bladder tumours for treatment and accurate staging of solitary transitional cell carcinoma of the bladder.
Materials and methods
April 2011 - February 2013, 67 patients ( 48 male – 19 female with non muscle-invasive bladder cancer (NMIBC) underwent transurethral en bloc resection using a Collins Loop. Tumor size ranged to 0.5- 45 mm and multifocality was present in 6% of cases. En bloc resection was applied on all of the tumours. On 59 of the 67 patients, a re-resection was performed after 6weeks. The bladder wall is incised around the lesion using a Collins loop, starting from apparently ‘ normal ’ mucosa surrounding the base and then extending through the subepithelial connective tissue, muscularis mucosae and muscularis propria strata. The resected 1-piece specimen was grasped with a loop electrode and retrieved. After bladder tumor resection the resected base was observed carefully to assess perforation and bleeding. When the tumor size was greater than 3 cm, excision of the lesion could be easily achieved by mean of a resectoscope with a 5 mm working channel. After resection, the lesion is grasped with the forceps and retrieved with the resectoscope. All cases of high-risk NMIBC underwent second-look after 30-45 days.
Results
Pathology reported urothelial carcinoma with low grade stage Ta, T1 high –grade and T2 high-grade respectively in 38 ( 56,7% ), 23 ( 34,3% ), 6 ( 8,9% ). All of the resected specimens provided detrusor muscle, No uncontrollable bleeding, perforation or other serious complications were observed. To date, with a mean follow up of 16.5 months, the recurrence rate in patients with NMIBC is 13.5%
Conclusion
CLebR has been proven safe and effective for both, treatment and pathological staging of NMIBC; therefore could be an appropriate tool for accurate staging with possibly lower scattering potential for the assessment and treatment of patients with NMIBC.
The objective advantage of accurate pathological examination ( identification of microfocal invasion of lamina propria or of muscular wall, surgical margins assessment ) is associated with a substantial safe technique. Long term data and larger dataset of cases are necessary to demonstrate an advantage in terms of recurrence or progression.