張哲維1,3,4, 耿俊閎1,2,3,4, 詹鎮豪1,2,3,4, 王巽玄1,3,4, 沈榮宗1,李永進1,2,3,4
高雄市市立小港醫院 泌尿部1；高雄醫學大學臨床醫學研究所2；高雄醫學大學附設醫院 泌尿部3；高雄醫學大學4
The Safety and Efficacy of Endoscopic Resection of Bladder Tumor with Vela Laser– A Single Center Experience
Che-Wei Chang1,3,4, Jiun-Hung Geng1,2,3,4, Jhan-Jhen Hao1,2,3,4, Hsun-Shuan Wang1,3,4, Rong-Zong Shen1 and Yung-Chin Lee1,2,3,4
1Department of Urology, Kaohsiung Municipal SiaoGang Hospital, Kaohsiung, Taiwan; 2Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 3 Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 4Kaohsiung Medical University, Kaohsiung, Taiwan
The current gold standard treatment of bladder cancer is transurethral resection of bladder tumor with Monopolar or Bipolar resectoscope (CTURBT). Laser en-bloc resection of bladder tumor (LERBT) could achieves higher quality of the specimen, reduces peri-operative complications, and may decreases the recurrence rate. Higher quality of the specimen could help differentiate between non-muscle and muscle invasive disease. Here, we compare the efficacy and safety of en-bloc Vela laser resection versus the conventional Monopolar/Bipolar resection.
Material and Methods
A total 64 clinically cTa-cT2 patients were retrospectively reviewed in this study. Among these patients, 34 patient received LERBT and 30 patients received CTURBT. The baseline characteristics, operation variables and clinical outcome were collected. The primary performance is the inclusion of muscle component in the specimen. Peri-operative complications and recurrence-free survival (RFS) were also compared. Independent t test, Chi-square test and Kaplan-Meier curves were used in the analysis.
The median age of patients in laser and resectoscope group are 66.8 and 67.2 years old, respectively. There is statistical difference in muscle inclusion rates that are 88.2% in laser group and 66.6% in resectoscope group (p=0.03). Also, we found shorter catheterization time (p=0.019), hospitalization time (p=0.007) and complicate rates (p=0.05) in LERBT group. However, no statistical difference was noted in RFS after median follow up time of 13 months.
Endoscopic laser en-bloc resection of bladder tumor with Vela laser is an effective method with higher muscle inclusion rate and fewer complications. The clinical outcomes of LERBT is non-inferior compared to CTURBT.