Efficacy and Safety Comparison between Thulium Laser Resection of Bladder Tumor and Transurethral Resection of Bladder Tumor
Introduction
Non-muscle-invasive bladder cancer (NMIBC) constitutes a significant proportion of the newly diagnosed bladder cancer cases. Transurethral resection of bladder tumor (TURBT) along with adjuvant therapy has been the primarily recommended in the treatment of NMIBC. However, TURBT is associated with several complications. Hence lasers such as Holmium YAG and Thulium YAG were introduced to overcome these drawbacks. The safety and efficacy of thulium laser resection of bladder tumor (TmLRBT) has been demonstrated in many studies.
Aim
The safety and efficacy of TmLRBT has been compared to the conventional TURBT to assess if TmLRBT could be a superior option in the treatment of NMIBC.
Method
Study Design
- Systematic review and meta-analysis.
Treatment Strategy
- PubMed, Scopus and Web of Science databases were comprehensively searched to identify the studies that compared the 2 techniques.
- For outcomes of continuous variables, weighted mean difference (WMD) was used to measure the difference and risk ratio (RR) with 95% confidence interval (CI) was estimated for binary variables.
Endpoints
- Operative time
- Postoperative catheterization time
- Length of hospital stay
- Incidence of intraoperative complications
- Duration of postoperative irrigation
Results
- The meta-analysis included 10 studies with 1558 patients.
- The baseline characteristics of two groups were comparable with respect to age, gender, tumor size, tumor location, tumor multiplicity.
- Both the groups had similar operative time (WMD 2.41 min; p = 0.24) and postoperative catheterization time (WMD -0.31 days; p = 0.41).
- The duration of hospital stay was shorter in TmLRBT group (WMD -0.58 days; p = 0.04).
- TmLRBT was associated with fewer intraoperative complications including obturator nerve reflex (RR 0.04; p < 0.001) and bladder perforation (RR 0.11; p < 0.001).
- The postoperative pathological assessment revealed a significantly lower identification rate of detrusor in the TURBT group (RR 0.84; p=0.02).
- Although the rate of postoperative irrigation did not significantly differ in our analysis (p = 0.28), the TmLRBT group had a significantly shorter duration of irrigation (p = 0.004).
- With respect to recurrence, there were no significant differences among the groups - overall recurrence (p = 0.052), 1-year recurrence (p = 0.23), and 2-year recurrence (p = 0.40).
Conclusion
- Thulium laser resection of bladder tumor (TmLRBT) was associated with a lower incidence of intraoperative complications and lower risk of postoperative bleeding as compared to transurethral resection of bladder tumor (TURBT).
- TmLRBT demonstrated a non-inferior efficacy to TURBT in cancer control.
- Since TmLRBT could also provide high-quality specimens for pathology diagnosis; it is an effective option for non-muscle-invasive bladder cancer (NMIBC).
Lasers Med Sci. 2021 Dec;36(9):1807-1816. Doi: 10.1007/s10103-021-03272-7.
