According to clinical guidelines, endoscopic surgery (mono- or bipolar TURBT, laser resection, en bloc resection) is a standard treatment option for patients with primary non-muscle invasive bladder cancer (NMIBC) (excluding carcinoma in-situ). However, more than half of patients will experience local recurrence after surgery. It is believed that one of the main causes for this local recurrence is the reimplantation of tumor cells during endoscopic surgery. It is crucial to limit contact between the resected tumor and the bladder wall during the operation and to extract the specimen as quickly as possible. In the case of a small tumor, the surgeon can immediately remove it using an endoscopic instrument. There are a number of methods available for removing large tumors, but it is not yet clear which one is most optimal. Therefore, comparing the oncological results from evacuating bladder tumors using various methods is very timely. Based on the previously mentioned studies, the investigators assume that the rate of bladder cancer relapse out site of the resection area would be lower in the morcellation group compared with piecemeal resection of the tumor. In order to prove this, the investigators plan to conduct a randomized study comparing the relapse rate in these two groups.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
180
Laser en bloc resection with subsequent tumor morcellation will be performed. This tissue will be sent for histology in order to estimate the histological subtype and differentiation grade. Next stage laser resection of the tumor basis will be performed with subsequent histology to determine the depth of invasion and the status of surgical margin.
Tumor piecemeal resection will be performed with electric loop. Then fragments of the tumor will be removed by the loop or Janet's syringe. Fragments from the base of the tumor will be sent separately in order to assess which stage the tumor is at and its surgical margin status.
Institute for Urology and Reproductive Health, Sechenov University.
Moscow, Russia
RECRUITINGRecurrence free survival
Absence of the tumor in the bladder during the follow-up cystoscopy
Time frame: 3 months
Relapse-free rate in-site of previous surgery
Absence of the tumor in the place of resection of the bladder wall during the follow-up cystoscopy
Time frame: 3 months
Relapse-free rate out-site of previous surgery
Absence of the tumor out of the place of resection of the bladder wall during the follow-up cystoscopy
Time frame: 3 months
Duration of surgery
Time frame from the beginning of the procedure till the end of the procedure
Time frame: Intraoperatively
Adverse events
Adverse events according to the Clavien-Dindo classification
Time frame: 3 months
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