Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
Urology. 2022 Jul;165:373. doi: 10.1016/j.urology.2022.04.021. Epub 2022 May 4.
The HoLERBT (Holmium Laser En-bloc Resection of Bladder Tumors) has emerged as an alternative to classical TURBT (Transurethral Resection of Bladder Tumor). Recent randomized trial and meta-analysis corroborate with the benefits in pathological analysis, perioperative and long-term oncological outcomes. However, the treatment of large tumors and the technique of extraction from the bladder is a problem to be overcome. OBJECTIVE: To describe the laser resection of bladder tumors and demonstrate the feasibility of this procedure even for large tumors throughout a series of cases. It is also discussed the quality of the histopathological analysis.
A series of 8 cases randomized selected to be the pilot for a trial comparing TURBT and HoLERBT in large tumors (>3 cm) in progress was analyzed (Brazilian Registry of Clinical Trials number RBR-67npwrk). The perioperative data and 1-year outcomes were assessed and the quality of histopathological analysis after morcellation was evaluated in terms of histopathology, grade, and stage. The entire procedure of one case is shown in a step-by-step video.
The mean follow-up was 12.6 months. The mean age was 59.6 (42-85) years, and the mean tumor size was 4.7 (4-8) cm. All the resections were En-bloc. There were 2 cases of NMIBC, 4 cases of MIBC, 1 paraganglioma, and 1 adenocarcinoma. The histopathological analysis confirmed the presence of detrusor muscle layer and accurate diagnosis and staging in all cases (100%). There were no perioperative Clavien-Dindo > 1 complications, no blood transfusion, and no bladder perforations. The histopathology analysis reveals excellent quality without artifacts of fulguration.
The holmium laser resection followed by morcellation of large bladder tumors is a feasible procedure. No complications occurred in our series of cases and all cases provided excellent material for histopathological analysis.
钬激光整块切除术（HoLERBT）已经成为经尿道膀胱肿瘤切除术（TURBT）的替代方法。最近的随机试验和荟萃分析证实了其在病理分析、围手术期和长期肿瘤学结果方面的优势。然而，对于大型肿瘤的治疗和从膀胱中提取的技术仍然是需要克服的问题。目的：描述膀胱肿瘤的激光切除术，并通过一系列病例展示即使对大型肿瘤也能进行此手术的可行性。还讨论了组织病理学分析的质量。
对 8 例患者进行了前瞻性选择，作为正在进行的一项比较 TURBT 和 HoLERBT 治疗大型肿瘤（>3cm）的试验的试点（巴西临床试验注册编号 RBR-67npwrk）。评估了围手术期数据和 1 年结果，并评估了在进行组织学分析时，组织学、分级和分期的准确性。展示了 1 例患者的整个手术过程的分步视频。
平均随访时间为 12.6 个月。平均年龄为 59.6 岁（42-85 岁），肿瘤平均大小为 4.7cm（4-8cm）。所有的切除均为整块切除。其中 2 例为非肌层浸润性膀胱癌（NMIBC），4 例为肌层浸润性膀胱癌（MIBC），1 例为副神经节瘤，1 例为腺癌。所有病例的组织病理学分析均证实了存在逼尿肌层且诊断和分期准确（100%）。无围手术期 Clavien-Dindo >1 级并发症、无输血和膀胱穿孔发生。组织病理学分析显示，没有电切术相关的伪影，质量非常好。
钬激光整块切除加膀胱肿瘤组织学粉碎术是一种可行的方法。在我们的病例系列中没有发生并发症，所有病例都提供了用于组织病理学分析的优质材料。
