Sollten wir alle zur En Bloc Resektion von Blasentumoren wechseln?

Zusammenfassung

Bei der En-Bloc-Resektion von Blasentumoren (ERBT) erfolgt die Abtragung von Tumoren nicht fragmentiert, sondern sie werden in einer Schicht präpariert und, wenn möglich, in toto extrahiert. Diese Methode repräsentiert einen Paradigmenwechsel in der Behandlung nicht muskelinvasiver Blasentumore und bietet gegenüber der konventionellen transurethralen Resektion der Blase (TUR-B) diverse Vorteile. Insbesondere erlauben die so gewonnen histologischen Präparate eine genauere Aufarbeitung, was eine präzisere Stadieneinteilung ermöglicht. Zudem wird häufiger Detrusormuskulatur im Präparat nachgewiesen, was auf eine komplettere Tumorentfernung hindeutet. In den letzten Jahren festigt sich eine stabile Datenbasis, die die Vorteile dieser Technik bekräftigt. So wurde kürzlich in einer multizentrischen, prospektiv-randomisierten Studie erstmals ein signifikanter Vorteil hinsichtlich der Rezidivrate nach 12 Monaten im Vergleich zur TUR-B nachgewiesen. Versierte Endourologen sollten sich mit dieser Technik befassen, da sie sich mittelfristig zum Standard entwickeln könnte. Die Technik ist zu gut und zu elegant, um ignoriert zu werden.

Abstract

In En-Bloc Resection of Bladder Tumours (ERBT), tumours are not removed in fragments, but are dissected in one layer and, if possible, extracted in one piece. This method represents a significant shift in the surgical management of non-muscle-invasive bladder tumours, providing multiple benefits over the traditional transurethral resection of the bladder (TUR-B). The histological analysis of ERBT specimens is more accurate, enhancing diagnostic precision. Additionally, the presence of detrusor muscle in ERBT specimens is more frequent, indicating a more complete removal of the tumours. Recent years have seen the consolidation of a robust evidence base emphasizing the advantages of ERBT. Notably, a multicentric, prospective randomized trial has recently revealed a significant reduction in recurrence rates at 12 months follow-up compared with TUR-B. Experienced endourologists should explore this technique, as it may soon become the standard of care. The techniqueʼs elegance and effectiveness make it too important to be ignored.

Schlüsselwörter

ERBT - En Bloc Resektion - TUR-B - Urothelkarzinom

Keywords

ERBT - NMIBC - TUR-B - urothelial carcinoma - en-bloc resection

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