膀胱惡性腫瘤經傳統尿道刮除手術與雷射整塊腫瘤切除術之比較-萬芳醫院之經驗

吳尉綱、溫玉清、林雍偉、林克勳

臺北市立萬芳醫院 泌尿科

Comparison of Standard Transurethral Resection of Bladder Tumor and Laser En-bloc Resection of Bladder Tumor: A Single-centered Experience from Taipei Municipal Wanfang Hospital  

Wei-Kung Wu, Yu-Ching Wen, Yung-Wei Lin, Ke-Hsun Lin

Department of Urology, Wan Fang Hospital, Taipei Medical University

Purpose: The aim of this study is to comparatively evaluate clinical outcomes of transurethral resection of bladder tumor(TURBT) and laser en-bloc resection of bladder tumor(ERBT) for bladder cancer and to present the findings as a real-world evidence.  

Materials and Methods: We retrospectively analyzed the cases of bladder tumor underwent TURBT or Laser ERBT since January 2020 to March 2023 by two urological surgeons who are experienced in the field of both techniques. Outcome measurements comparing TURBT and Laser ERBT for bladder cancer were detrusor muscle acquisition rate, pathologic tumor stage, recurrent rate and median time to recurrence.

Results: Twenty-one patient received 31 times of TURBT and twenty-two patients received 22 times of Laser ERBT were included in the study. Regard to demographics, age and gender ratio were similar in both groups, whereas follow-up period is longer in Laser ERBT group (16.1±7.5 months vs 11.7±7.1 months). Higher detrusor muscle acquisition rate was found in Laser ERBT group but there are no significant difference between groups (TURBT: 82.1% ; Laser ERBT: 90.4%, p=0.40). Distributions of tumor stage and tumor grade were similar in both groups(TURBT : T0a/Tis/T1 - 71%, ≧T2 - 29% ; Laser ERBT : T0a/Tis/T1 - 77%, ≧T2 - 23%). Recurrent rates in T0a/Tis/T1 stage were also similar (TURBT : 37.5% ; Laser ERBT : 40%, p=0.89), but showed significant differences in T2-stage-patient who were mostly received adjuvant chemotherapy or CCRT without radical cystectomy(TURBT : 100% ; Laser ERBT : 20%, p=0.016). There was no significant difference with regard to median time to recurrence in both groups (TURBT: 7 months; Laser ERBT: 6 months, p=0.57).

Conclusion: Laser ERBT for bladder cancer own the potential benefit in detrusor muscle acquisition and aids in accurate staging, thus decreased the risk of second-look TURBT. Besides, lower recurrence was found in T2 stage patient received Laser ERBT and CCRT, which might because by a potential R0 resection.