[The influence of "differentiated trandurethral resection" in the recurrence and progression of superficial bladder cancer].
OBJECTIVE
Experimental data show the relationship between the area of injured urothelium and recurrence rates in superficial bladder cancer. Tumor cell adherence is increased by the exposure to the extracellular matrix (ECM). Transurethral resection uncovers the ECM and might lead to recurrent tumors. The question if recurrences are increased by enlarged urothelium resection areas is difficult to answer because there will be no prospective studies available. We investigated if deeper and larger urothelial injuries, which are caused by differentiated resections lead to higher recurrence and progression rates than regular resections of bladder tumors.


METHODS
163 patients with superficial bladder cancer were retrospectively evaluated. Sixty-six received a differentiated resection and 97 a regular one. We analyzed the recurrence and progression rates over a minimum of 48 months as well as tumor persistence in the second resection.


RESULTS
Patients with differentiated resections of bladder tumors were found to have no higher incidence of tumor recurrence and progression but showed a significantly higher percentage of tumor free second resections.


CONCLUSIONS
As a model of enlarged urothelial lesions the differentiated resection technique for superficial bladder cancer has no negative influence on recurrence or progression rates. It seems unlikely that the extracellular matrix uncovered by resection is the main reason for the high recurrence rates. The significantly lower incidence of tumor persistence in the second resection favors the differentiated resection technique in the transurethral treatment.
Angbein
Sigrun
S
Departmento de Urología, Universidad de Mannheim, Facultad de Medicina de Heidelberg, Alemania. sigrun.langbein@uro.ma.uni-heidelberg.de
Guzmán
Sergio
S
Haecker
Axel
A
Weib
Christel
C
Michel
Maurice-Stephan
MS
Alken
Peter
P
Siegsmund
Michael
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000379:methods*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D014521:Urethra; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*