Clinical Significance of Horizontal and Vertical Margin of En Bloc Resection for Nonmuscle Invasive Bladder Cancer

No AccessJournal of UrologyAdult Urology1 Aug 2021Clinical Significance of Horizontal and Vertical Margin of En Bloc Resection for Nonmuscle Invasive Bladder Cancer Takafumi Yanagisawa, Jun Miki, Keigo Sakanaka, Wataru Fukuokaya, Kosuke Iwatani, Shun Sato, Koki Obayashi, Shinichi Hirooka, Takahiro Kimura, Hiroyuki Takahashi, and Shin Egawa Takafumi YanagisawaTakafumi Yanagisawa *Correspondence: Department of Urology, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba , 277-8567Japan telephone: +81-4-7164-1111; FAX: +81-4-7166-9374; E-mail Address: [email protected] http://orcid.org/0000-0002-7410-0712 Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author , Jun MikiJun Miki Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author , Keigo SakanakaKeigo Sakanaka Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author , Wataru FukuokayaWataru Fukuokaya Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author , Kosuke IwataniKosuke Iwatani Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author , Shun SatoShun Sato Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author , Koki ObayashiKoki Obayashi Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author , Shinichi HirookaShinichi Hirooka Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author , Takahiro KimuraTakahiro Kimura Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author , Hiroyuki TakahashiHiroyuki Takahashi Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author , and Shin EgawaShin Egawa Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001735AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The primary advantage of en bloc resection of bladder tumors is to provide better diagnostic accuracy. However, the clinical significance of horizontal and vertical margin has not been demonstrated. We evaluated the clinical importance of surgical margins in patients who underwent en bloc resection of bladder tumors. Materials and Methods: We retrospectively analyzed the records of 140 consecutive patients who underwent en bloc resection of bladder tumors for nonmuscle invasive bladder cancer. We analyzed perioperative and oncological outcome, and compared patient demographics and recurrence-free survival for horizontal findings. The relationship between surgical margin and second transurethral resection outcome in pT1 bladder cancer was also analyzed. Results: Mean tumor diameter was 17.2±9.8 mm. Pathological stages were 93 cases in pTa and 47 cases in pT1. Diagnostic rates for the horizontal and vertical margins were 63% and 99%, respectively. The rates of sessile, carcinoma in situ, high grade, and pT1 tumors were significantly higher in the horizontal margin positive group (41) than in the negative group (47). There was no significant difference in 2-year recurrence-free survival based on horizontal margin findings (negative: 72.4%, positive: 75.4%, p=0.87). A second transurethral resection was performed in 31 of the 47 pT1 patients; pT1 residue was seen only in vertical margin positive cases, and 5 pTa/pTis residues at the transurethral resection scar were seen in 15 horizontal margin positive patients. Conclusions: Horizontal margin positive findings were not associated with recurrence-free survival, but careful assessment is warranted regarding residue at the original site. A second transurethral resection should be considered in patients with horizontal and vertical margin positive pT1 bladder cancer. 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JM contributed to protocol/project development and manuscript editing. SS and SH contributed to pathological diagnosis. KS, WF, KI, and KO contributed to data collection. TK, HT, and SE contributed to manuscript editing. Ethics Approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByYanagisawa T, Mori K, Motlagh R, Kawada T, Mostafaei H, Quhal F, Laukhtina E, Rajwa P, Aydh A, König F, Pallauf M, Pradere B, D'Andrea D, Compérat E, Miki J, Kimura T, Egawa S and Shariat S (2022) En Bloc Resection for Bladder Tumors: An Updated Systematic Review and Meta-Analysis of Its Differential Effect on Safety, Recurrence and HistopathologyJournal of Urology, VOL. 207, NO. 4, (754-768), Online publication date: 1-Apr-2022. Volume 206Issue 2August 2021Page: 252-259 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Keywordsmargins of excisionurinary bladder neoplasmsAcknowledgmentsEnglish-language editorial support was provided by Seaman Medical, Inc., Bellingham, Washington, USA.MetricsAuthor Information Takafumi Yanagisawa Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan *Correspondence: Department of Urology, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba , 277-8567Japan telephone: +81-4-7164-1111; FAX: +81-4-7166-9374; E-mail Address: [email protected] More articles by this author Jun Miki Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author Keigo Sakanaka Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author Wataru Fukuokaya Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author Kosuke Iwatani Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author Shun Sato Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author Koki Obayashi Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author Shinichi Hirooka Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author Takahiro Kimura Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author Hiroyuki Takahashi Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author Shin Egawa Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author Expand All Author Contribution: TY contributed to protocol/project development, data collection and management, data analysis, and manuscript writing/editing. JM contributed to protocol/project development and manuscript editing. SS and SH contributed to pathological diagnosis. KS, WF, KI, and KO contributed to data collection. TK, HT, and SE contributed to manuscript editing. Ethics Approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. Advertisement Loading ...