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Inicio Actas Urológicas Españolas (English Edition) Immediate post-operative intravesical instillation of a single dose chemotherapy...
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Vol. 46. Issue 8.
Pages 464-472 (October 2022)
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Vol. 46. Issue 8.
Pages 464-472 (October 2022)
Original article
Immediate post-operative intravesical instillation of a single dose chemotherapy is not superior to continuous saline irrigation
La dosis única de instilación intravesical postoperatoria inmediata de quimioterapia no es superior al lavado continuo con suero
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L. Türkeria, N. Karşıyakalıa,
Corresponding author
nkarsiyakali@hotmail.com

Corresponding author.
, G. Aslanb, M. Akgülc, S. Baltacıd, D. Bolate, H. Şahinf, E. Karabayg, V. İzolh, İ. Tinayi, Members of Turkish Urooncology Association, Bladder Cancer Study Group 1
a Department of Urology, Acibadem M.A. Aydinlar University, Altunizade Hospital, Istanbul, Turkey
b Department of Urology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
c Department of Urology, Namik Kemal University, Faculty of Medicine, Tekirdag, Turkey
d Department of Urology, Ankara University, Faculty of Medicine, Ankara, Turkey
e Department of Urology, University of Health Sciences, Bozyaka Training and Research Hospital, Izmir, Turkey
f Department of Urology, Mugla Sitki Kocman University, Faculty of Medicine, Mugla, Turkey
g Department of Urology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
h Department of Urology, Cukurova University, Faculty of Medicine, Adana, Turkey
i Department of Urology, Marmara University, Faculty of Medicine, Istanbul, Turkey
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Abstract
Introduction and objectives

To evaluate whether there is any difference between immediate postoperative instillation of intravesical chemotherapy (IPOIC) and continuous saline bladder irrigation (CSBI) in terms of bladder cancer (BC) recurrence in patients with primary low- or intermediate-risk non-muscle-invasive BC (NMIBC).

Materials and methods

Medical records of 1482 patients who underwent transurethral resection of bladder tumor between March 1994 and August 2020 were reviewed retrospectively. Patients were divided into two groups according to IPOIC and/or CSBI administration status [Group-1 = CSBI alone; Group-2 = CSBI following IPOIC]. Low- and intermediate-risk NMIBC patients were also divided into subgroups according to IPOIC and/or CSBI administration status.

Results

A total of 594 patients with primary NMIBC were included. Of the patients, 86 (14.5%) were female and 508 (85.5%) were male with a median age of 69 (60–78) years. The frequency of patients in Group-1 and Group-2 were 361 (60.8%) and 233 (39.2%), respectively. Recurrent disease was observed in 213 (35.9%) patients. There was no difference between the groups when they were compared for recurrent disease frequency, median time to first recurrence and frequency of recurrence within first 12 months (P = .064, P = .671, and P = .145, respectively). Disease recurrence rates in low-risk NMIBC patients was lower when they were treated with “CSBI following IPOIC” when compared to “CSBI alone” (P = .042). However, no difference was observed in low-risk NMIBC subgroups when they were compared for pathological features of recurrent tumors such as number, size, grade, stage, and presence of carcinoma in situ (P > .05, for each).

Conclusions

“CSBI following IPOIC” combination was not superior to “CSBI alone” for preventing adverse pathological outcomes in recurrent low- and intermediate-risk NMIBC.

Keywords:
Continuous saline bladder irrigation
Immediate postoperative instillation of intravesical chemotherapy
Intravesical chemotherapy
Non-muscle-invasive bladder cancer
Transurethral resection of bladder tumors
Resumen
Introducción y objetivos

Evaluar si existe alguna diferencia entre el efecto de la instilación intravesical de quimioterapia postoperatoria inmediata (IQPI) y el del lavado vesical continuo con suero salino (LVCS) en la recidiva del cáncer de vejiga (CV) en pacientes con CV primario de riesgo bajo o intermedio sin invasión muscular (CVSIM).

Materiales y métodos

Se revisaron retrospectivamente las historias clínicas de 1.482 pacientes sometidos a resección transuretral de tumor de vejiga entre marzo de 1994 y agosto de 2020. Los pacientes se dividieron en dos grupos según el tratamiento administrado de IQPI y/o LVCS [Grupo-1 = solo LVCS; Grupo-2 = LVCS tras IQPI]. Los pacientes con CVSIM de riesgo bajo e intermedio también se dividieron en subgrupos según el tipo de tratamiento administrado: IQPI y/o LVCS.

Resultados

Se incluyeron 594 pacientes con CVSIM primario. De los pacientes, 86 (14,5%) eran mujeres y 508 (85,5%) eran hombres, con una edad media de 69 (60–78) años. La frecuencia de pacientes en el Grupo-1 y el Grupo-2 fue de 361 (60,8%) y 233 (39,2%), respectivamente. Se observó enfermedad recurrente en 213 (35,9%) pacientes. No hubo diferencias entre los grupos al comprar la frecuencia de la enfermedad recurrente, la mediana de tiempo hasta la primera recidiva y la frecuencia de la recidiva en los primeros 12 meses (p = 0,064, p = 0,671 y p = 0,145, respectivamente). Las tasas de recidiva en los pacientes con CVSIM de bajo riesgo fueron menores cuando recibieron tratamiento con «LVCS tras IQPI» en comparación con «solo LVCS» (p = 0,042). Sin embargo, no se observaron diferencias en los subgrupos de CVSIM de bajo riesgo al comparar las características patológicas de los tumores recurrentes como el número, el tamaño, el grado, el estadio y la presencia de carcinoma in situ (p > 0,05, para cada una).

Conclusiones

La combinación «LVCS tras IQPI» no fue superior al tratamiento único con «LVCS» en la prevención de resultados patológicos adversos en el CVSIM recurrente de riesgo bajo e intermedio.

Palabras clave:
Lavado vesical continuo con suero
Instilación intravesical de quimioterapia en postoperatorio inmediato
Quimioterapia intravesical
Cáncer vesical sin invasión muscular
Resección transuretral de tumor vesical

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