Many bladder cancer patients come to my website to ask why the doctor told me to have another bladder electrosurgery one month after the first one. These patients often have a question: Is it because the doctor didn’t make a clean cut in the first surgery? Your question may be answered after reading this small article on science.
Transurethral resection of bladder tumor (TURBT) has two purposes: one is to remove the entire tumor visible to the naked eye, i.e. treatment; the other is to stage and grade the resected tumor tissue pathologically in order to clarify the postoperative treatment and assess the prognosis of the patient. In the past 10 years, the concept of secondary electrosurgery has been gradually proposed at home and abroad: i.e., electrosurgery is performed again within 2 to 6 weeks after the initial electrosurgery.
The main reasons for this are: ① The positive rate of residual bladder tumor after the first electrosurgery is high, even in large cancer centers in the United States and Europe this figure is as high as 30-52%, so it is necessary to perform a second TUR to remove the residual tumor tissue. ② A comparative analysis of pathological specimens after secondary TUR and those after the first surgery revealed that the pathological staging after secondary TUR was higher than that of the initial surgery in 10-20% of patients, especially those patients whose initial TUR did not reach the muscular layer or whose muscular layer was not seen in the specimen. Inaccurate staging can also affect the choice of subsequent treatment options and prognostic assessment of the patient.
Why is such a high rate of tumor positivity found in re-electrolysis within a short period of time (2-6 weeks) after electrosurgery? These factors may be related to: (1) the multicentric and multiple biology of bladder cancer: latent early tumors are easily missed; high-grade tumors are highly malignant, and tumors are prone to implantation and intravesical metastasis; (2) of course, the quality of the initial electrosurgery is also crucial: if the initial electrosurgery does not reach the muscular layer or if the muscular layer is not visible in the specimen, the rate of positive tumor detection by repeat electrosurgery increases significantly.
Therefore, for patients with high-grade or combined in situ bladder cancer, patients whose muscle layer is not seen in the initial electrosurgery specimen, patients with stage T1 bladder cancer, and patients with tumor diameter greater than 3 cm or multiple bladder cancers, secondary electrosurgery is recommended within 2-6 weeks after surgery in order to accurately stage, reduce postoperative tumor recurrence, and better control bladder tumors. At present, secondary electrosurgery is unanimously recommended in domestic and international bladder cancer treatment guidelines and has become the current standard treatment method.