Category: Clinical Oncology: Outcomes & Complications
Introduction & Objective :
To date en bloc resection of non-muscle-invasive bladder cancer (NMIBC) is regarded by urologists as a promising surgical option. Previous studies have shown that en bloc resection of bladder tumors (ERBT) provides a high quality specimen with a muscle layer in 96-100% of cases, while conventional transurethral resection of bladder tumors (cTURB) in only 50-86% of cases. Different energy sources can be used for ERBT (electrocautery, laser, cyber-knife). Laser energy seems to be preferable due to absence of obturator nerve reflex and very precise resection. This study aims to evaluate the feasibility, safety and efficacy of thulium fiber laser en bloc resection of NMIBC.
71 laser en bloc resections for NMIBC with thulium fiber laser (Urolase, IRE Polus, Russia) were performed from 2015 to 2016. The mean tumor size was 2.28±0.15 cm. The mean tumor number was 1,72±0.18. Tumors location: lateral bladder wall – 43%; close to ureteral orifice – 25.4%; bladder neck – 4.2%; posterior bladder wall – 19,7%; anterior bladder wall – 4.2%; bladder triangle – 3.5%. The laser settings were as follows: 1J, 10Hz, 10W. Rigid 24Ch/26Ch resectoscope and flexible cystoscope with 600 and 400 μm laser fibers were used.
Operating time, specimen quality, intra- and postoperative complications (obturator nerve reflex, bladder wall perforation, bleeding), recurrence rate at 6, 12,18 months postop were evaluated.
Results : The average operating time was 38,7±1.87 min (10 – 80 min). Detrusor muscle was present in 91.55% of specimens. However, detrusor tissue was absent only in the specimens after a couple of first procedures. No obturator nerve stimulation, bladder wall perforation or significant bleeding were observed. Early mitomycin C instillation in all cases was done. Recurrence rates at 6, 12, 18 months postoperatively were 9.86%, 11.27% and 2.81%, respectively.
Thulium laser en bloc resection of bladder cancer is a safe and effective procedure for NMIBC treatment. Apparently, it gives acceptable recurrence and low complication rates providing high quality specimen for proper staging and decision-making on further management strategy.
Alim Dymov– Urologist, Sechenov University, Moscow, Moskva, Russia
Leonid Rapoport– Deputy Director, RI for Uronephrology, Sechenov University, Moscow, Moskva, Russia
Andrey Vinarov– Sechenov University, Moscow, Moskva, Russia
Dmitry Enikeev– Deputy Director for Science, Institute for Urology and Reproductive health, Sechenov University, Moscow, Moskva, Russia
Nikolay Sorokin– Sechenov University, Moscow, Moskva, Russia
Roman Sukhanov– Sechenov University, Moscow, Moskva, Russia
Dmitry Kislyakov– Sechenov University, Moscow, Moskva, Russia
Alexandra Proskura– Sechenov University, Moscow, Moskva, Russia
Vladimir Lekarev– Sechenov University, Moscow, Moskva, Russia
Akhmed Damiev– Sechenov University, Moscow, Moskva, Russia
RI for Uronephrology, Sechenov University
Moscow, Moskva, Russia
Deputy Director for Science
Institute for Urology and Reproductive health, Sechenov University
Moscow, Moskva, Russia
Experienced in TURP (>300 surgeries).
Experienced in upper urinary tract endosurgery (PCNL >200, RIRS >200).
2008-Present: Multiple upper and lower urinary tract surgeries;
2011-Present: HoLEP (400 surgeries);
2011-Present: En-bloc enucleation of bladder tumor (50 surgeries);
2016-Present: ThuLEP (>400 surgeries);
2016-Present: Thulium en-bloc enucleation of bladder tumor (>80 surgeries);
2016-Present: Brachytherapy (>40 surgeries); prostate cryoablation (70 surgeries), renal cancer cryoablation (30 surgeries);
Apr 2017-Present: Irreversible electroporation (10 surgeries);
Apr 2017-Present: MR-fusion prostate biopsy (80 procedures).