SACİT NURİ GÖRGEL, Mahmoud MUSTAFA, Cengiz GİRGİN, Çetin DİNÇEL

Yüzeyel mesane tümöründe re tur tedavi seçeneklerini değiştirebilir mi?

Amaç: Bu çalışmada yüzeyel mesane tümörlü hastalarda, yeniden evreleme amaçlı transüretral mesane tümör rezeksiyonunun (Re-TURMT) tedavi şeklini değiştirip değiştiremeyeceği araştırıldı. Gereç ve Yöntem: Transüretral rezeksiyon (TUR) ve re-TURMT yapılan toplam 59 hasta (yaş ortalaması 63.25, yaş aralığı 29-85 olan 53 erkek, 6 kadın) çalışmaya dahil edildi. Tüm hastalar yüzeyel mesane tümörü tanısı almıştı; 27 hastanın evresi pTa, 32 hastanın evresi pT1 idi. Tümörlerin grade dağılımı; 15 hastada grade I, 23 hastada grade II ve 21 hastada grade III idi. Re-TURMT ilk rezeksiyondan 4-6 hafta sonra yapıldı. Re-TURMT ilk rezeksiyon bölgesinden ve şüpheli lezyonlardan yapıldı. Tüm hastalar, tümöral lezyonlarının evresi, grade’i, tümör boyutu ve tümör lokalizasyonu açısından değerlendirildi. Onkolojik özellikler; rezidü tümör varlığı ve düşük evreleme sıklığı şeklinde değerlendirildi. Bulgular: Rezidü tümör 19 (% 32.20) hastada saptanmıştır. Bu hastaların evreleri; 15 hastada (%78.50) pT1, 4 hastada (%21.50) pTa idi. Tüm rezidü tümörler ilk rezeksiyon alanında veya rezeksiyon alanı sınırında saptandı. Düşük evreleme pT1 5 hastada (%26.31) gözlendi ve üç hastanın tanısı carsinoma in situ (CIS) olarak değişti. İlk evresi TaG1 olan hastalarda Re-TURMT sonrası patolojik tanıda değişiklik saptanmadı. Hiçbir hastada grade progresyonu gözlenmedi. Sonuç: Re-TURMT’de rezidüel tümör saptama oranı tüm yüzeyel mesane tümörlerinde düşük değildir. Patolojik tanı değişikliği saptanması ve ilk TUR’da düşük evreleme olasılığı nedeniyle Re-TURMT, özellikle pT1GIII yüzeyel mesane tümörlerinin tedavi seçeneklerinde değişikliğe neden olmaktadır.

Restaging transurethral resection for superficial bladder tumor; may it changes the treatment options?

Objective: This study was an evaluation of whether restaging transurethral resection of superficial bladder tumor(TUR-BT) may change the treatment modalities in patients with superficial bladder tumor. Material and Methods: A total of 59 patients with mean age of 63.25 years; range 29-85, (53 male, 6 female) who underwent transurethral resection (TUR) and restaging TUR-BT were enrolled. All patients were diagnosed to have superficial bladder tumor; pTa 27 patients, pT1 32 patients. The grades of the tumors were; 15 patients had grade I, 23 patients had grade II and 21 patients had grade III. Restaging TUR (Re-TUR) was done after 4-6 weeks of the first resection. The tumoral lesions were evaluated in terms of stage, grade, tumor volume and tumor location. The repeat resection was done from the region of initial resection and suspicious lesions. The oncologic findings were evaluated in terms of presence of residual tumor and incidence of under staging. Results: Residual tumor was found in 19 (32.20%) patients, including pT1 15(78.49%) patients and pTa 4 (21.50%) patients and all the tumor were detected at the regions of initial resection. Under staging was observed in 5 pT1 (26.31%) patients, and three patients changed diagnosis to carcinoma insitu (CIS). None of the patients with Ta grade 1 showed under staging or change in diagnosis at Re-TUR. No patient showed progression regards of grades. Conclusion: The rate of detecting residual tumoral lesions at restaging transurethral resection is not low in all pathological subgroups. The alterations of pathological diagnosis at Re-TUR and the under staging at initial TUR mandated the change in the treatment options especially in pT1 grade III cases.

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