Abstract

BACKGROUND:

Repeat transurethral resection of bladder tumor is recommended when certain risk constellations are present on initial resection. Current evidence is conflicting, leading to dissenting recommendations in multinational guidelines around the world. Photodynamic diagnostics (PDD) is a tool which has been shown to increase diagnostic accuracy, but evidence is still lacking if this may permit omission of repeat resections in certain cases.

OBJECTIVE:

To evaluate whether the use of photodynamic diagnostics has an impact on resection quality and residual tumor rate, and to explore which parameters may have an impact on the necessity of repeat transurethral resections.

METHODS:

We retrospectively evaluated 373 patients in the timeframe of ten years, in whom a repeat transurethral resection of bladder tumor has been performed following initial resection at our department. About half of those resections were performed using photodynamic diagnostics.

RESULTS:

When PDD was used, more tumor mass was revealed and resected, but the shown trend toward a lower residual tumor rate was non-significant. Muscularis was shown more often on PDD resections. While being a rare occurrence, upstaging on repeat resection happened significantly less often after initial PDD use. Furthermore, tumor size and multifocality significantly influenced residual tumor rate in Ta high-grade stage.

CONCLUSIONS:

PDD use may lead to a more accurate initial staging but this may not have an impact on short-term residual tumor rate. Tumor size and multifocality should be granted more weight in the decision-making process as when to perform a repeat resection.

中文翻译：

---

决定何时省略浅表膀胱癌的经尿道重复切除术：光动力诊断对您有帮助吗？

摘要

背景：

当初次切除时存在某些危险星座时，建议重复经尿道膀胱肿瘤切除术。当前的证据相互矛盾，导致全球多国准则中的建议不一致。光动力诊断（PDD）是一种可以提高诊断准确性的工具，但是在某些情况下是否可以省略重复切除仍缺乏证据。

目的：

评估使用光动力学诊断方法是否会影响切除质量和残余肿瘤发生率，并探讨哪些参数可能会影响再次经尿道切除的必要性。

方法：

我们在十年内回顾性评估了373例患者，这些患者在我科首次切除后已进行了再次经尿道膀胱肿瘤切除术。这些切除术中约有一半是使用光动力学诊断法进行的。

结果：

当使用PDD时，发现并切除了更多的肿瘤块，但是显示出的降低残余肿瘤发生率的趋势并不显着。在PDD切除术中更经常显示肌肉瘤。虽然很少见，但在最初使用PDD后，重复切除术的升级发生的频率明显降低。此外，肿瘤大小和多灶性显着影响了Ta高分期的残余肿瘤发生率。

结论：

使用PDD可能会导致更准确的初始分期，但这可能不会对短期残留肿瘤发生率产生影响。肿瘤大小和多灶性应在决策过程中给予更大的重视，就像何时进行重复切除一样。