Chang Che-Wei, Tang Tsz-Yi, Geng Jiun-Hung, Jhan Jhen-Hao, Wang Hsun-Shuan, Shen Jung-Tsung, Lee Yung-Chin
Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 81267, Taiwan.
Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
J Clin Med. 2022 Sep 5;11(17):5233. doi: 10.3390/jcm11175233.
(1) Background: The current gold standard treatment of bladder cancer is conventional transurethral resection of the bladder tumor (CTURBT) using monopolar or bipolar resectoscopes. Laser en-bloc resection of the bladder tumor (LERBT) could achieve a higher quality of the specimen, reduce perioperative complications, and decrease the recurrence rate. Here, we compare the efficacy and safety of en-bloc Vela laser resection versus the conventional monopolar/bipolar resection; (2) Methods: A total of 100 clinically cT1-2 patients with bladder cancer were retrospectively reviewed in this study. Among these patients, 50 patients received LERBT, and 50 patients received CTURBT. The baseline characteristics, operation variables, and clinical outcomes were collected. The primary performance was the presence of muscle layer in the specimen. Perioperative complications and recurrence-free survival (RFS) were also compared. Independent -test, Chi-square test, Kaplan-Meier curves, and the Cox-regression model were used in the analysis; (3) Results: The median age of the patients in the laser and resectoscope groups was 69.2 and 68.0 years old, respectively. The statistical difference in the presence of the detrusor muscle was 92.0% in the laser group and 70.0% in the CTURBT group ( = 0.005). A lower incidence of bladder perforation ( = 0.041) and major surgical complications ( = 0.046) in the LEBRT group was observed. We found no differences in operation duration, catheterization time, and hospitalization time after adjustment. Additionally, there was no statistical difference in RFS after a median follow-up time of 25 months; (4) Conclusions: Endoscopic laser en-bloc resection of bladder tumor with Vela laser is an effective method with higher muscle inclusion rate and fewer complications.
(1) 背景：目前膀胱癌的金标准治疗方法是使用单极或双极膀胱电切镜进行传统经尿道膀胱肿瘤切除术（CTURBT）。膀胱肿瘤激光整块切除术（LERBT）能够获得更高质量的标本，减少围手术期并发症，并降低复发率。在此，我们比较了整块Vela激光切除术与传统单极/双极切除术的疗效和安全性；(2) 方法：本研究回顾性分析了100例临床诊断为cT1-2期的膀胱癌患者。其中，50例患者接受LERBT，50例患者接受CTURBT。收集患者的基线特征、手术变量和临床结局。主要指标是标本中肌层的存在情况。还比较了围手术期并发症和无复发生存期（RFS）。分析采用独立样本t检验、卡方检验、Kaplan-Meier曲线和Cox回归模型；(3) 结果：激光组和电切镜组患者的中位年龄分别为69.2岁和68.0岁。激光组逼尿肌肌层存在率为92.0%，CTURBT组为70.0%，差异有统计学意义（P = 0.005）。观察到LEBRT组膀胱穿孔（P = 0.041）和主要手术并发症（P = 0.046）的发生率较低。调整后，我们发现手术时间、导尿时间和住院时间无差异。此外，中位随访25个月后，RFS无统计学差异；(4) 结论：使用Vela激光进行内镜下膀胱肿瘤激光整块切除术是一种有效的方法，肌层包含率更高，并发症更少。
