Bladder cancer (BC) is the one of the most prevalent cancer in Egypt representing nearly
30% of all cancers. Approximately 75% of newly diagnosed BC present with non-muscle
invasive disease (NMIBC). Initial treatment for most BCs includes transurethral resection
(TUR) of the tumor to obtain tissues sufficient for histo-pathological examination to
determine if the tumor reaches the muscular proprietary or not.
In the setting of non muscle invasive urothelial carcinoma (NMIBC) especially T1HG,
several studies showed a benefit of performing repeat resection within 2- 6 weeks to
ensure adequate resection and exclude invasion of muscle layer.
However, several issues make this recommendation ie. Re-TUR at least debatable . First,
most of these recommendations are based on heterogenous studies that didn't report cancer
specific survival (CSS). The risk of upstaging to muscle-invasive disease at re-TUR i did
not exceed 7% in recent series . Moreover, the potential complications of re TUR that
include bladder perforation and extravasation may delay administration of intravesical
BCG and this delay is associated with increased risk of tumor recurrence and progression.
On the other hand, several studies have demonstrated that presence of detrusor muscle
(DM) in the initial specimen is a surrogate marker of resection quality and was
associated with less incidence of residual tumor at the re TUR. New techniques like
En-bloc resection of bladder tumour (ERBT) entails a circumferential incision around the
tumor with 5-10 mm safety margin, then proceed to deep muscle layer underneath the tumor
where it is dissected using a combination of blunt dissection and laser or diathermy
energy. This technique allows accurate assessment of the depth of invasion and the
infiltration pattern of NMIBC and thus improving the accuracy of pathological diagnosis.
Recently published articles on this topic reported a higher rate of detrusor muscle in
the specimen (96%) with enbloc compared to conventional TURB.
In a retrospective analysis of 106 patients with pT1 bladder cancer treated with ERBT, 50
patients underwent re-TUR and no significant benefits in terms of RFS and PFS to
performing a reTUR in all patients with pT1 on initial ERBT.
Residual tumors were found in 6 patients (12%) and none of them were upstaged to T2
disease. Interestingly, no residual disease or recurrence overtime at the initial ERBT
site in patients with negative horizontal safety margins and residual tumor was found in
2 out of 45 patients with negative vertical safety margins
Aim of Work
The aim of this study is to assess the impact of avoiding re TUR after initial enbloc
resection of primary tumor with negative safety margins on recurrence free survival (RFS)
,progression free survival (PFR) and cancer specific survival (CSS ) in patients with pT1
bladder cancer through a RCT.