Die En bloc-Resektion von Blasentumoren (ERBT) – eine Bestandsaufnahme

Zusammenfassung

Hintergrund Als Limitationen der konventionellen transurethralen Resektion von Harnblasentumoren (cTURB) als Standardverfahren zur Detektion und Behandlung von nicht muskelinvasivem Blasenkrebs (NMIBC) sind Stagingfehler aufgrund unzureichender Resektionstiefe ebenso wie die intravesikale Fragmentierung der Proben, die eine histopathologische Begutachtung erschweren, bekannt. Diese Übersichtsarbeit soll die aktuelle Datenlage zur En bloc-Resektion von Harnblasentumoren (ERBT) beleuchten und das große Potenzial der Technik hervorheben.

Patienten/Material und Methoden Auswertung der relevanten, PubMed-gelisteten Originalartikel, Übersichtsarbeiten und Metaanalysen zu den Suchbegriffen „bladder cancer” und „en bloc”.

Ergebnisse Die ERBT bietet eine durchgängig hochwertige Resektionsqualität mit wechselnden Nachweisraten von Tunica muscularis in den Resektionsproben. Diese ist der Surrogatmarker der Resektionsqualität in Hinblick auf muskelinvasive Tumoren. Die ERBT kann mit allen Energiequellen, auch in Kombination (Hybridverfahren), sicher durchgeführt werden. Die aktuellen Daten zeigen, dass kein signifikanter Unterschied in Bezug auf die perioperative Morbidität im Vergleich zur cTURB besteht. In Bezug auf die Rezidivraten kann noch keine abschließende Beurteilung getroffen werden, da hier die Datenlage zum Teil kontrovers ist.

Schlussfolgerung Die ERBT hat in den letzten Jahren an Bedeutung gewonnen. Die vermuteten Vorteile gegenüber der cTURB wie bessere Probenqualität und bessere histopathologische Beurteilbarkeit und damit verbessertes Staging scheinen sich für Tumoren mit einer Größe bis zu 4 cm zu bestätigen. Die Auswirkungen auf die Tumorrezidivrate bleibt Gegenstand zukünftiger Studien auf diesem Gebiet.

Abstract

Limitations inherent in the conventional transurethral resection of bladder tumours, the standard approach for diagnosis and treatment of bladder cancer, are well known: staging errors due to insufficient resection depth as well as intravesical tumour fragmentation, both of which make histopathological evaluation difficult. The purpose of this review is to present recent clinical data on the en-bloc resection of bladder tumours (ERBT), which has been demonstrated to offer a high potential to overcome these limitations. The recent findings show that ERBT provides a good resection quality with varying detection rates for tunica muscularis, which is a surrogate marker for resection quality regarding muscle-invasive tumours. ERBT can be performed using all energy sources. Available data show no relevant difference with regard to perioperative morbidity compared with cTURB. No conclusions can be drawn regarding the impact of ERBT on recurrence as the data are partly controversial. This has to be defined by further studies.

Schlüsselwörter

Harnblasenkrebs - En bloc Resektion - Laser - transurethrale Resektion - Blasentumor

Keywords

bladder cancer - bladder carcinoma - en-bloc resection of bladder tumour - laser - transurethral resection - bladder tumour

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