Clinically, according to the degree of differentiation of bladder tumor cells, the size and number of tumors, and the presence or absence of carcinoma in situ, non-muscle invasive bladder cancer is divided into three groups: high-risk, intermediate-risk, and low-risk. Patients in the high-risk group have the greatest risk of recurrence and progression after surgery, followed by the intermediate-risk group, and progression hardly occurs in the low-risk group although recurrence can occur.
1, low-risk non-muscle invasive uroepithelial carcinoma of the bladder Solitary, Ta, G1 (low-grade uroepithelial carcinoma), diameter << span="">3 cm (Note: you must have both of these conditions to be a low-risk non-muscle invasive bladder carcinoma).
2.High-risk non-muscle invasive uroepithelial carcinoma of bladder Multiple or high recurrence, T1, G3 (high-grade uroepithelial carcinoma), Tis. 3.Moderate-risk non-muscle invasive uroepithelial carcinoma of bladder Other than the above two categories, including tumor multiple, Ta ~ T1, G1 ~ G2 (low-grade uroepithelial carcinoma), diameter > 3 cm, etc.
The chance of tumor recurrence after the first electrosurgery is higher in intermediate and high-grade T1 bladder cancer than in low-risk bladder cancer. The literature reports that the recurrence rate of high-risk non-muscle invasive bladder cancer is 61% and progression rate is 17% within one year after elective resection, while the recurrence and progression rates are as high as 78% and 45% within 5 years, respectively. Re-electrodesiccation of non-muscle invasive bladder cancer within a short period of time after initial electrodesiccation, especially for those with high-risk stage T1 bladder cancer, can reduce postoperative tumor recurrence and progression rates, and can result in more accurate tumor pathologic staging. The literature reports that re-electrodesis can reduce the postoperative tumor recurrence rate from 63.24% to 25.68% and the tumor progression rate from 11.76% to 4.05% in patients with stage T1 bladder cancer. As for when to perform re-excision after the first electrosurgery is still inconclusive, most scholars suggest that it should be performed within 2 to 6 weeks after the first electrosurgery.
Why is such a high rate of tumor positivity found with re-electrodesis within a short period of time (2-6 weeks) after electrosurgery? It may be related to these factors: the multicentric and multiple biology of bladder cancer, the latent early tumors in easily missed; the high malignancy of high-grade tumors, the ease of tumor implantation and intravesical metastasis; and of course the quality of the initial electrosurgery is also crucial, especially if the initial electrosurgery did not cut into the muscular layer or the muscular layer was not seen in the specimen, the rate of positive tumor detection by re-electrosurgery increases significantly. Therefore, for patients with high-risk non-myelomeninvasive bladder cancer, especially for those who do not see myelomeningocele in the specimen, secondary excision should be performed so that the presence of tumor residue and myelomeninvasive infiltration can be clarified. Currently, most international medical centers recommend secondary electrosurgery for high-risk non-muscle invasive bladder cancer, and it is strongly recommended in bladder cancer treatment guidelines in order to completely resect the tumor as early as possible and further reduce the chance of tumor recurrence and progression.