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Fluorescence-guided bladder tumour resection: impact on survival after radical cystectomy

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To investigate whether photodynamic diagnosis (PDD)-guided bladder tumour resection (TUR-BT) is of prognostic value in patients undergoing subsequent radical cystectomy (RC) for bladder cancer (BC).


In 224 consecutive patients who underwent RC and bilateral pelvic lymphadenectomy for BC between 2002 and 2010 (median follow-up 29 months [IQR 8–59]), we retrospectively investigated whether patients had previously undergone PDD-guided (hexaminolevulinate [HAL] vs. 5-aminolevulinate [ALA]) versus white light (WL)-TUR-BT. Kaplan–Meier analysis was used to estimate recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS) using log-rank and Cox regression model for uni- and multivariable analysis.


Of the 224 patients, 66 (29.5 %) underwent HAL-, 23 (10.3 %) ALA- and 135 (60.2 %) WL-TUR-BT before RC. The 3-year RFS/CSS/OS was 77.8/83.9/74.0 % for HAL-, 53.6/74.5/60.9 % for ALA- and 52.4/59.7/56.5 % for WL-TUR-BT (p = 0.002/0.023/0.037 for HAL vs. WL/ALA). PDD-TUR-BT was associated with a higher number of TUR-BTs before RC (p < 0.001) and re-resections (p = 0.015), a longer time between the first TUR-BT and RC (p = 0.044) and a lower rate of post-operative systemic chemotherapy (p = 0.001). In multivariable analysis, performance of HAL-TUR-BT, pathologic tumour and nodal stage as well as soft tissue surgical margin status were independent predictors for RFS, CSS and OS.


This series indicates for the first time that HAL-guided TUR-BT is an independent predictor for improved survival after RC.

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Conflict of interest

G. Gakis and A. Stenzl have received speaker honoraria from IPSEN Pharma GmbH, Ettlingen, Germany. All other authors have nothing to disclose. No funding was obtained for this study.

Ethical standard

This study was approved by the Local Ethics Committee, Tübingen, and conducted according to the Declaration of Helsinki and according to the STROBE statement (see supplementary material).

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Correspondence to Georgios Gakis.

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Gakis, G., Ngamsri, T., Rausch, S. et al. Fluorescence-guided bladder tumour resection: impact on survival after radical cystectomy. World J Urol 33, 1429–1437 (2015).

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