Laser en bloc resection of bladder tumors: a European multi-center study to evaluate safety, efficacy and outcome
M. Wolters1, M.W. Kramer1, A.S. Merseburger1, M. Riedl2, A. Leitenberger2, A. Martov*3, N. Baykov*3, M.A. Kuczyk1, A.J.Gross4, D.A. Leavitt*5, A.D. Smith*5, T.R.W. Herrmann1
1Medizinische Hochschule Hannover, Klinik für Urologie und Urologische Onkologie, Hannover, Deutschland, 2KlinikumWolfsburg, Klinik für Urologie, Wolfsburg, Deutschland, 3Moscow City Hospital No. 57, Department of Urology, Moskau,Russische Föderation, 4Asklepios Klinik Barmbek, Klinik für Urologie, Hamburg, Deutschland, 5The Arthur Smith Institute forUrology, New Hyde Park, New York, Vereinigte Staaten von Amerika
Introduction: En bloc resection of bladder tumors (ERBT) has been shown to be a valuable alternative, although TURBTremains the gold standard. Major goal of ERBT is to enhance staging quality by avoiding tissue fragmentation and increasingthe rate of detrusor muscle. The objective of this multi-center study was to evaluate safety, efficacy and recurrence rates ofpatients treated by laser ERBT of non-muscle invasive bladder cancer (NMIBC).
Material and methods: Three academic hospitals provided prospectively collected data of patients treated by laser ERBT.Patients´ characteristics, clinical and pathologic data were assessed. Complications were recorded using the Clavien-Dindoclassification. Laser en bloc resection was carried out either with a Thulium:YAG or a Holmium:YAG laser. Operations wereperformed in a similar fashion by all study centers. Follow-up was carried out based on EAU guidelines.
Results: 65 patients were treated by laser ERBT between 6/2010 to 4/2014. Pathology revealed 39 patients with pTa and 26patients with pT1 tumors. All specimens included detrusor muscle, edges were free of tumor in all cases and 100% of biopsiesfrom the tumor ground were negative. One operation was switched to conventional transurethral resection. Only 3 (4.6%)complications =3 were recorded. No obturator nerve reflex appeared. 54 patients with primary urothelial carcinoma of thebladder and a minimum follow-up of 12 months revealed a cumulative recurrence rate of 18.5%. Recurrences within the formerresection area were noticed in 2 of 10 patients.
Conclusion: Laser en bloc resection of bladder tumors is safe and effective for treatment and staging of NMIBC. Lasers mightalso be of favor for patients with higher risk of bleeding due to its effective hemostatic properties. In-field recurrences seem tobe decreased.