Modified transurethral resection of bladder tumors: A comparison study of chemotherapy-enhanced endoscopic submucosal en bloc dissection versus conventional resection.

Abstract

721 Background: High recurrence rates plague patients with nonmuscle invasive bladder cancer (NMIBC) following transurethral resection of bladder tumors (TURBT). In response, we have developed a modified TURBT procedure that integrates en bloc resection, endoscopic submucosal dissection, and the injection of chemotherapeutic drugs into the submucosa (cESD-TURBT).This study aims to determine if cESD-TURBT yields better outcomes than conventional TURBT (cTURBT). Methods: This retrospective observational study was conducted on patients diagnosed with cTa–T1 bladder cancer who received TURBT between December 2020 and July 2023 in Liaoning Cancer Hospital. Participants were grouped based on the type of treatment they received: cESD-TURBT (n=118) or conventional TURBT (cTURBT, n=105). Hydroxycamptothecin was the chemotherapeutic agent used for submucosal injections. The primary outcome was recurrence-free survival (RFS) of the treated bladder cancer. Secondary outcomes included disease recurrence within one year, operation duration, length of postoperative hospitalization, and complication rates. Statistical analyses were performed using appropriate tests, with a threshold of P < 0.05 defined as statistically significant. Results: Among the 223 patients, cESD-TURBT cohort demonstrated enhanced RFS compared to cTURBT cohort, with a median follow-up of 775 days (IQR 414-1040). The recurrence rate in the cESD-TURBT cohort was 18.64% (22/118), against 39.05% (41/105) in the cTURBT cohort, with a log-rank hazard ratio of 0.49 (95% CI 0.29-0.82; p=0.0053). Furthermore, cESD-TURBT registered fewer postoperative complications than cTURBT, markedly reducing occurrences such as the obturator reflex (2% vs. 9%). The difference in operation times was not statistically significant, with cESD-TURBT averaging 49.0 ± 21.0 minutes and cTURBT 44.3 ± 23.8 minutes, the difference being statistically negligible (p=0.127). Conclusions: For patients with NMIBC, cESD-TURBT significantly lowers recurrence rates compared to cTURBT and is associated with fewer postoperative complications. Our study reveals that the chemotherapy-enhanced ESD-TURBT technique significantly improves recurrence-free survival and reduces complications, making it a superior method over conventional TURBT for bladder tumor removal.