Prospective non-randomized comparison of transurethral laser en bloc resection vs. conventional resection of bladder tumors larger than 3 cm.

Autor:	Petov V; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia - vladislav.s.petov@gmail.com., Timofeeva E; Institute for Clinical Medicine Named After N.V. Sklifosovsky, Sechenov University, Moscow, Russia., Sukhanov R; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia., Baniel J; Division of Urology, Rabin Medical Center, Petah Tikva, Israel.; Sackler Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel., Mustafin M; Institute for Clinical Medicine Named After N.V. Sklifosovsky, Sechenov University, Moscow, Russia., Fajkovic H; Department of Urology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria., Morozov A; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia., Teoh JY; Department of Surgery, S.H. Ho Urology Center, Chinese University of Hong Kong, Hong Kong, China., Singla N; Brady Urological Institute, School of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA., Laukhtina E; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.; Department of Urology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Herrmann TR; Urology Spital Thurgau AG, Frauenfeld, Switzerland.; Hannover Medical Scholl MHH, Hannover, Germany.; Stellenbosch University Western Cape, Stellenbosch, South Africa., Shariat SF; Department of Urology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.; Department of Urology, Weill Cornell Medical College, New York, NY, USA.; Department of Urology, University of Texas Southwestern, Dallas, TX, USA.; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic., Enikeev D; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.; Division of Urology, Rabin Medical Center, Petah Tikva, Israel.; Department of Urology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
Jazyk:	angličtina
Zdroj:	Minerva urology and nephrology [Minerva Urol Nephrol] 2024 Aug; Vol. 76 (4), pp. 436-441.
DOI:	10.23736/S2724-6051.24.05682-9
Abstrakt:	Background: En bloc resection of bladder tumor (ERBT) is an established surgical treatment method for patients with non-muscle invasive bladder cancer (NMIBC) in tumors less than 3 cm. Data regarding the efficacy and safety of ERBT on larger than 3 cm tumors are sparse and its efficacy compared to conventional transurethral resection (TURBT) remains unclear. The aim of this study was to prospectively compare the feasibility, safety and oncological outcomes of laser (Tm-fiber) ERBT and TURBT in patients with primary bladder lesions ≥3 cm. Methods: A cohort of 45 patients who underwent surgery for primary NMIBC between February 2018 and March 2022 was collected prospectively. There was no randomization. All procedures were performed by two experienced surgeons. Inclusion criteria were as follows: age >18 years, primary Ta or T1 bladder tumor with a diameter of ≥3 cm, no more than 3 tumors and no history of upper tract urothelial carcinoma. Exclusion criteria were carcinoma in situ or invasion into muscle layer (≥T2). ERBT was performed with thulium fiber laser (IPG, Russia). Primary endpoints included efficacy with recurrence-free survival (RFS) at 3, 6 and 12 months. Secondary endpoints were safety parameters, perioperative data and specimen quality (the presence of muscle layer in specimens). Results: Twenty-eight patients underwent laser ERBT and 17 conventional TURBT. The location and size of the tumors were comparable in both groups. The success rate was 93.3% in the ERBT group with two cases of conversion from ERBT to TURBT. Detrusor muscle was present in 92.8% patients in the ERBT group versus 70.5% in the TURBT group (P=0.04). Obturator nerve reflex was observed only in the TURBT group: 17.6% vs. 0.0% (P=0.02). The frequency of other complications was comparable between the two groups. RFS was not statistically different between the two methods at 3 (93.9% vs. 94.1%, P=0.87), 6 (89.3% vs. 82.3%, P=0.5) and 12 months (89.3% vs. 70.6%, P=0.11). Conclusions: Laser ERBT is a feasible and safe procedure to manage bladder tumors larger than 3 cm. While it seems safer than TURBT, its effect on efficacy remains to be assessed in larger trials.
Databáze:	MEDLINE
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