title: "En Bloc" Resection of Nonmuscle Invasive Bladder Cancer: A Prospective Single-center Study.
abstract: OBJECTIVE
  To describe our "en bloc" technique for nonmuscle invasive bladder cancer (NMIBC), assess the quality of resection, and report the midterm oncological outcome.
  
  
  METHODS
  This is an observational prospective longitudinal study, from June 2010 to February 2014, enrolling patients with clinically NMIBC, having tumors of ≤3 cm and ≤4 lesions who underwent electrical en bloc bladder resection. The primary study end point was recurrence-free survival. Secondary outcomes were feasibility, safety, the presence of detrusor muscle, and the recurrence rate at the first follow-up cystoscopy (3 months). Statistical analysis was complemented with multivariable analysis.
  
  
  RESULTS
  Of 87 enrolled patients, 2 showed a nonurothelial carcinoma and 11 showed muscle invasive bladder carcinoma at the definitive pathology. The study cohort consisted of 74 transitional cell carcinoma NMIBC cases, mean age 71 years ± 8, presenting with a mean tumor diameter of 1.98 ± 0.59 cm and a median number of resected tumors per patients of 1 (range 1-4). The 2-year recurrence-free survival was 85.59%. All the en bloc resection of bladder tumor samples showed the presence of detrusor muscle and the recurrence rate at the first follow-up cystoscopy (3 months) was 5.4% (4/74). An extraperitoneal bladder perforation occurred in only one patient. At multivariable analysis, only gender and the presence of carcinoma in situ were independent predictors of recurrence. The midterm follow-up and the absence of a control group are the main limitations.
  
  
  CONCLUSIONS
  Our findings confirmed the feasibility and safety of en bloc resection of bladder tumor, with a recurrence-free survival of 85% after 2 years.
authors.affiliation: Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano (Milan), Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Hurle
authors.affiliation: Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano (Milan), Italy. Electronic address: massimo.lazzeri@humanitas.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Lazzeri
authors.affiliation: Department of Pathology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano (Milan), Italy.
authors.forename: Piergiuseppe
authors.initials: P
authors.lastname: Colombo
authors.affiliation: Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano (Milan), Italy.
authors.forename: NicolòMaria
authors.initials: N
authors.lastname: Buffi
authors.affiliation: Biostatistic Unit, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano (Milan), Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Morenghi
authors.affiliation: Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano (Milan), Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Peschechera
authors.affiliation: Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano (Milan), Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Castaldo
authors.affiliation: Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano (Milan), Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Pasini
authors.affiliation: Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano (Milan), Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Casale
authors.affiliation: Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano (Milan), Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Seveso
authors.affiliation: Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano (Milan), Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Zandegiacomo
authors.affiliation: Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano (Milan), Italy.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Taverna
authors.affiliation: Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano (Milan), Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Benetti
authors.affiliation: Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano (Milan), Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lughezzani
authors.affiliation: Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano (Milan), Italy.
authors.forename: Girolamo
authors.initials: G
authors.lastname: Fiorini
authors.affiliation: Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano (Milan), Italy; Department of Pathology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano (Milan), Italy; Biostatistic Unit, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano (Milan), Italy; Department of Urology, Humanitas Clinical and Research Center, Humanitas University, Rozzano (Milan), Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Guazzoni
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009361:Neoplasm Invasiveness; D011446:Prospective Studies; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*