Abstract
Purpose
To evaluate the practicability of en bloc transurethral resection with 2-micron continuous-wave laser as treatment for primary non-muscle-invasive bladder cancer (NMIBC).
Methods
This was a single-center, randomized, controlled trial involving 142 patients with newly diagnosed NMIBC. All patients were randomly assigned in a 1:1 ratio to receive either laser treatment or conventional transurethral resection of bladder tumor (TURBT). All patients received intravesical chemotherapy. Follow-up was performed in 18 months. Primary outcome measure was difference of tumor recurrence rate at the end of study.
Results
Baseline characteristics did not differ between patients in two groups. Operation time was longer in laser group than in TURBT group (56.5 ± 37.4 vs. 41.0 ± 29.4 min, P = 0.017). Obturator nerve reflection was noted during TURBT in 18 patients, whereas none was noted during laser resection. Number of T1 tumors was higher in the laser group (25 vs. 15, P = 0.047). According to Kaplan–Meier survival curves, there was no statistical difference in the rate of recurrence in 18 months (P = 0.383). All recurrences were out of the site of first resection, and there was no progression in tumor grade.
Conclusion
Two-micron continuous-wave laser did not diminish tumor recurrence rate in primary NMIBC for 18-months observation. However, T1 tumors were significantly higher among laser group. Clear and complete tumor bases were easily conserved by laser resection, which may enable pathologists to distinguish the T stages of bladder cancer more easily. Further studies need to be done in future.
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References
Cheung G, Sahai A, Billia M, Dasgupta P, Khan MS (2013) Recent advances in the diagnosis and treatment of bladder cancer. BMC Med 11:13
Si-wei Z, Jian-hui M, Ming L, Yan-qun N, Wan-qing C (2009) Bladder neoplasms incidence trend cancer registry China. J Chin J Urol 10:4
Babjuk M, Oosterlinck W, Sylvester R, Kaasinen E, Bohle A, Palou-Redorta J, Roupret M (2011) EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder, the 2011 update. Eur Urol 59:997–1008
Shindo T, Masumori N, Kitamura H, Tanaka T, Fukuta F, Hasegawa T, Yanase M, Miyake M, Miyao N, Takahashi A et al (2013) Clinical significance of definite muscle layer in TUR specimen for evaluating progression rate in T1G3 bladder cancer: multicenter retrospective study by the Sapporo Medical University Urologic Oncology Consortium (SUOC). World J Urol [Epub ahead of print]
Roupret M, Seisen T, Comperat E, Larre S, Mazerolles C, Gobet F, Fetissof F, Fromont G, Safsaf A, d’Arcier BF et al (2013) Prognostic interest to discriminate muscularis mucosae invasion (T1a vs. T1b) in non-muscle-invasive bladder carcinomas: results from a French national multicentre study with a central pathology review. J Urol 189:2069–2076
Soloway MS, Lopez AE, Patel J, Lu Y (1994) Results of radical cystectomy for transitional cell carcinoma of the bladder and the effect of chemotherapy. Cancer 73:1926–1931
Abd El-Latif A, Watts KE, Elson P, Fergany A, Hansel DE (2013) The sensitivity of initial transurethral resection or biopsy of bladder tumor(s) for detecting bladder cancer variants on radical cystectomy. J Urol 189:1263–1267
Pietrow PK, Smith JA Jr (2001) Laser treatment for invasive and noninvasive carcinoma of the bladder. J Endourol 15:415–418; discussion 425–6
Bachmann A, Woo HH, Wyler S (2012) Laser prostatectomy of lower urinary tract symptoms due to benign prostate enlargement: a critical review of evidence. Curr Opin Urol 22:22–33
Bader MJ, Sroka R, Gratzke C, Seitz M, Weidlich P, Staehler M, Becker A, Stief CG, Reich O (2009) Laser therapy for upper urinary tract transitional cell carcinoma: indications and management. Eur Urol 56:65–71
Herrmann TR, Liatsikos EN, Nagele U, Traxer O, Merseburger AS (2012) EAU guidelines on laser technologies. Eur Urol 61:783–795
Yang Y, Wei ZT, Zhang X, Hong BF, Guo G (2009) Transurethral partial cystectomy with continuous wave laser for bladder carcinoma. J Urol 182:66–69
Liu H, Xue S, Ruan Y, Sun X, Han B, Xia S (2011) 2-micrometer continuous wave laser treatment for multiple non-muscle-invasive bladder cancer with intravesical instillation of epirubicin. Laser Surg Med 43:15–20
Zhong C, Guo S, Tang Y, Xia S (2010) Clinical observation on 2 micron laser for non-muscle-invasive bladder tumor treatment: single-center experience. World J Urol 28:157–161
Bol MG, Baak JP, Buhr-Wildhagen S, Kruse AJ, Kjellevold KH, Janssen EA, Mestad O, Ogreid P (2003) Reproducibility and prognostic variability of grade and lamina propria invasion in stages Ta, T1 urothelial carcinoma of the bladder. J Urol 169:1291–1294
Lipponen PK, Eskelinen MJ, Jauhiainen K, Harju E, Terho R, Haapasalo H (1993) Grading of superficial bladder cancer by quantitative mitotic frequency analysis. J Urol 149:36–41
Lamm DL, Blumenstein BA, Crawford ED, Montie JE, Scardino P, Grossman HB, Stanisic TH, Smith JA Jr, Sullivan J, Sarosdy MF et al (1991) A randomized trial of intravesical doxorubicin and immunotherapy with bacille Calmette-Guerin for transitional-cell carcinoma of the bladder. N Engl J Med 325:1205–1209
Ukai R, Kawashita E, Ikeda H (2000) A new technique for transurethral resection of superficial bladder tumor in 1 piece. J Urol 163:878–879
Saito S (2001) Transurethral en bloc resection of bladder tumors. J Urol 166:2148–2150
Wilby D, Thomas K, Ray E, Chappell B, O’Brien T (2009) Bladder cancer: new TUR techniques. World J Urol 27:309–312
Maurice MJ, Ponsky LE (2013) En bloc transurethral resection of bladder lesions: a trick to retrieve specimens up to 4.5 cm. BJU Int 111:E15–E16
Nieder AM, Meinbach DS, Kim SS, Soloway MS (2005) Transurethral bladder tumor resection: intraoperative and postoperative complications in a residency setting. J Urol 174:2307–2309
Syed HA, Biyani CS, Bryan N, Brough SJ, Powell CS (2001) Holmium:YAG laser treatment of recurrent superficial bladder carcinoma: initial clinical experience. J Endourol 15:625–627
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The authors declare that they have no conflicts of interest.
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Ethical approval was obtained from the Ethics Committee of the Medical Faculty of the First Affiliated Hospital, Sun Yat-Sen University. Clinical data were obtained with the written consent of the patients.
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Chen, X., Liao, J., Chen, L. et al. En bloc transurethral resection with 2-micron continuous-wave laser for primary non-muscle-invasive bladder cancer: a randomized controlled trial. World J Urol 33, 989–995 (2015). https://doi.org/10.1007/s00345-014-1342-1
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DOI: https://doi.org/10.1007/s00345-014-1342-1