Can a second resection be avoided after initial thulium laser endoscopic en bloc resection for non-muscle invasive bladder cancer? A retrospective single-center study of 251 patients

Wenhao Zhou,Tingmang Yan,Guofang Du,Wenbo Wu,Wei Wang,Haitao Liu

doi:10.1186/s12894-020-00599-1

Abstract

BackgroundThis study aimed to evaluate the efficacy of transurethral thulium laser en bloc resection of the bladder tumor (TmLRBT) in patients with non-muscle invasive bladder cancer (NMIBC) and to investigate whether a second resection can be avoided.MethodsFrom June 2012 to June 2018, 251 newly diagnosed patients with NMIBC were enrolled in this retrospective study; all patients received regular administration of pirarubicin after the initial resection. A second transurethral resection (TUR) was performed in patients within 2–6 weeks after the initial TmLRBT in group 1. Patients in group 2 only underwent cystoscopy at 3 months.ResultsSecond surgery results indicate that recurrence was detected histopathologically in 6/108 and 11/143 patients in group 1 and 2, respectively (P = 0.52); Progression was observed in 2 patients in each group (P = 0.34). The mean follow-up duration was 40.1 months, with no significant difference between the groups (P = 0.32). Recurrence was observed in 23 (21.3%) and 39 (27.3%) patients in groups 1 and 2 during the follow-up, respectively (P = 0.34); disease progression occurred in 4 (3.8%) patients in group 1 compared with 7 (4.0%) in group 2 (P = 0.20).ConclusionComplete removal of tumors can be achieved by TmLRBT. This technique may decrease the number of second TURs.

Highlights

This study aimed to evaluate the efficacy of transurethral thulium laser en bloc resection of the bladder tumor (TmLRBT) in patients with non-muscle invasive bladder cancer (NMIBC) and to investigate whether a second resection can be avoided
Transurethral resection of the bladder tumor (TURBT) followed by intravesical instillation represents the gold standard for the treatment of non-muscle invasive bladder cancer (NMIBC)
To ensure that complete resection is performed and the correct diagnosis is rendered, various en bloc resection techniques have been applied in several studies, e.g., the modified loop J-shaped needle electrode by Ukai et al [19], holmium laser by Saito et al for tumors at the bladder neck [20], and thulium laser by Wolters et al, who demonstrated the presence of detrusor muscle (DM) in all cases [21]

Summary

Introduction

This study aimed to evaluate the efficacy of transurethral thulium laser en bloc resection of the bladder tumor (TmLRBT) in patients with non-muscle invasive bladder cancer (NMIBC) and to investigate whether a second resection can be avoided. All visible tumors can be removed and adequate specimens can be harvested by transurethral resection (TUR). This technique helps render the correct diagnosis and prevent early tumor recurrence and progression, thereby conferring a good prognosis [1]. As for a second TUR, which is mandatory in cases of incomplete first resection, is currently recommended for high-grade Ta (TaHG) tumors and all T1 tumors [1], staging errors may be corrected and residual tumors can be detected [3], it may lead to a significantly increased risk of complications and higher costs, which, to some degree, denotes the failure of the initial resection [4]. With the help of new techniques, a second TUR can be avoided and the overall treatment costs can be reduced

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