Candela Luigi, Ventimiglia Eugenio, Solano Catalina, Chicaud Marie, Kutchukian Stessy, Panthier Frederic, Corrales Mariela, Villa Luca, Briganti Alberto, Montorsi Francesco, Salonia Andrea, Doizi Steeve, Traxer Olivier
Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milan, Italy.
Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, GRC n. 20 Lithiase Renale, 75013 Paris, France.
J Clin Med. 2023 Jul 26;12(15):4907. doi: 10.3390/jcm12154907.
Thulium lasers (TLs), namely the Thulium fiber laser (TFL) and the Thulium:YAG (Tm:YAG), are being increasingly adopted for the conservative treatment of upper urinary tract urothelial carcinoma (UTUC). However, to date, the real clinical impact of TLs on UTUC management remains not well-characterized. We performed a review of the literature to summarize the current evidence on TLs for UTUC treatment.
We performed a systematic review in January 2023 using the Embase and Medline online databases, according to the PRISMA recommendations and using the PICO criteria. Outcomes of interest were: (i) to assess the safety and feasibility of TLs in the treatment of UTUC, and (ii) to evaluate the oncological outcomes in terms of tumor recurrence and conservative treatment failure. Moreover, we described TL characteristics and its interaction with soft tissue.
a total of 458 articles were screened, and six full texts including 273 patients were identified. All the included studies were retrospective series. Mean patient age ranged from 66 to 73 years. The indication of a conservative treatment was elective and imperative in 21.7-85% and 15-76% of cases, respectively. Laser power settings varied from 5 to 50 W. No intraoperative complications were reported, and all the procedures were successfully performed. The tumor recurrence rate was 17.7-44%, and the indication to radical nephroureterectomy was 3.7-44% during a follow-up of 6-50 months. Most of the postoperative complications were mild and transient, and ureteral strictures were reported in two studies. Major limitations were the retrospective nature of the studies, the small sample sizes, and the short follow-up.
TL is an effective and safe technology for endoscopic UTUC treatment. However, current available literature lacks prospective and multicentric studies with large population sizes and long-term follow-up.
铥激光（TLs），即铥光纤激光（TFL）和掺铥钇铝石榴石激光（Tm:YAG），越来越多地被用于上尿路尿路上皮癌（UTUC）的保守治疗。然而，迄今为止，铥激光对UTUC治疗的实际临床影响仍未得到充分描述。我们对文献进行了综述，以总结目前关于铥激光治疗UTUC的证据。
我们根据PRISMA建议并使用PICO标准，于2023年1月在Embase和Medline在线数据库中进行了系统综述。感兴趣的结果包括：（i）评估铥激光治疗UTUC的安全性和可行性，以及（ii）从肿瘤复发和保守治疗失败方面评估肿瘤学结果。此外，我们描述了铥激光的特性及其与软组织的相互作用。
共筛选出458篇文章，确定了6篇全文，包括273例患者。所有纳入研究均为回顾性系列研究。患者平均年龄在66至73岁之间。保守治疗的指征在21.7%至85%的病例中为选择性，在15%至76%的病例中为必要。激光功率设置从5瓦到50瓦不等。未报告术中并发症，所有手术均成功完成。在6至50个月的随访期间，肿瘤复发率为17.7%至44%，根治性肾输尿管切除术的指征为3.7%至44%。大多数术后并发症为轻度且短暂，两项研究报告了输尿管狭窄。主要局限性在于研究的回顾性性质、样本量小以及随访时间短。
铥激光是一种用于内镜下UTUC治疗的有效且安全的技术。然而，目前现有的文献缺乏大样本量和长期随访的前瞻性多中心研究。
