Mancon Stefano, Soria Francesco, Hurle Rodolfo, Enikeev Dmitry, Xylinas Evanguelos, Lusuardi Lukas, Heidenreich Axel, Gontero Paolo, Compérat Eva, Shariat Shahrokh F, D'Andrea David
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Department of Biomedical Sciences, Humanitas University, Milan, Italy.
World J Urol. 2025 Mar 27;43(1):191. doi: 10.1007/s00345-025-05565-w.
To comprehensively evaluate the efficacy of different energy sources used for en-bloc transurethral resection of bladder tumors (ERBT) on perioperative outcomes.
This sub-analysis derived from a prospective randomized study that enrolled patients undergoing ERBT vs conventional transurethral resection of the bladder (cTURB) from January 2019 to January 2022 (NCT03718754). Endpoints were pathological specimen quality and perioperative outcomes after either monopolar (m-ERBT) or bipolar (b-ERBT) or laser (l-ERBT) ERBT.
237 bladder tumors resected in 188 patients included in the analyses: 29 (12.2%) m-ERBT, 136 (57.4%) b-ERBT and 72 (30.4%) l-ERBT. Detrusor muscle (DM) was detected in 191 (80.6%) specimens. Per-tumor analysis revealed comparable rate of DM in the specimens obtained via different energy modalities (p = 0.7). Operative time was longer in the l-ERBT cohort compared to m-ERBT and b-ERBT (p = 0.02) and no obturator nerve reflex (ONR) onset was reported. On logistic regression analysis, b-ERBT was associated with negative lateral resection margins (OR 2.81; 95% CI 1.02-7.70; p = 0.04). There was no significant association of the resection technique with perforation and conversion rates (all p > 0.05). Within a median follow up of 22mo (IQR 11-29), a total of 35 (18.6%) patients had a local recurrence. On Cox regression analysis, patients resected with b-ERBT were less likely to have a recurrence (HR 0.34; 95% CI 0.15-0.78; p = 0.01); When adjusting for established confounders, this association was confirmed (HR 0.24; 95% CI 0.10-0.60; p = 0.002).
Different energy sources might achieve comparable perioperative outcomes. Further perspectives involve the assessment of long-term differential oncological outcomes associated with various energy modalities.
全面评估用于整块经尿道膀胱肿瘤切除术（ERBT）的不同能量源对围手术期结局的疗效。
本亚组分析源自一项前瞻性随机研究，该研究纳入了2019年1月至2022年1月期间接受ERBT与传统经尿道膀胱切除术（cTURB）的患者（NCT03718754）。终点指标为单极（m-ERBT）、双极（b-ERBT）或激光（l-ERBT）ERBT后的病理标本质量和围手术期结局。
分析纳入的188例患者共切除237个膀胱肿瘤：29例（12.2%）为m-ERBT，136例（57.4%）为b-ERBT，72例（30.4%）为l-ERBT。191个（80.6%）标本中检测到逼尿肌（DM）。肿瘤层面分析显示，不同能量方式获取的标本中DM发生率相当（p = 0.7）。与m-ERBT和b-ERBT相比，l-ERBT组的手术时间更长（p = 0.02），且未报告闭孔神经反射（ONR）发作。逻辑回归分析显示，b-ERBT与阴性侧切缘相关（OR 2.81；95%CI 1.02-7.70；p = 0.04）。切除技术与穿孔率和中转率无显著关联（所有p>0.05）。在中位随访22个月（IQR 11-29）期间，共有35例（18.6%）患者出现局部复发。Cox回归分析显示，接受b-ERBT切除的患者复发可能性较小（HR 0.34；95%CI 0.15-0.78；p = 0.01）；在调整既定混杂因素后，这种关联得到证实（HR 0.24；95%CI 0.10-0.60；p = 0.002）。
不同能量源可能实现相当的围手术期结局。进一步的研究方向包括评估与各种能量方式相关的长期肿瘤学差异结局。
