Previous series showed the safety and feasibility of en-bloc resection of non-muscle invasive bladder cancer (NMIBC) by different techniques. Here, we present our “en bloc” thullium laser technique for NMIBC, assess the quality of resection and report the preliminary functional and oncological outcome.
This is an observational prospective longitudinal study, enrolling patients with clinically NMIBC, having tumors of ≤ 3 cm and ≤ 4 lesions, who underwent thullium laser en-bloc bladder resection. A circular incision was made around the tumor with the tip of laser fiber maintaining a distance of approximately 5-10 mm from the tumor edge. This incision was carried out in macroscopically ‘normal’ mucosa surrounding the base and then extending through the sub epithelial connective tissue, muscularis mucosae and muscularis propria layers throughout detrusor muscle. The muscular fibers were sectioned cautiously from the periphery to the centre of the lesion base. Finally, the lesion was detached from the bladder wall and the tumor was extracted with an Ellick evacuator or by a nephroscopy sheet and laparoscopic grasp (i.e. Schneider) were used. The primary study end-point was recurrence-free survival. Secondary outcomes were: feasibility, safety, the presence of detrusor muscle (DM) and the recurrence rate at the first follow-up (3 months) cystoscopy (RRFF-C). Statistical analysis was complemented with multivariable analysis.
The study cohort consisted of 34 NMIBC cases, mean age 73 yrs ± 9, presenting with a mean tumour diameter of 1.9 ± 0.51 cm and a median number of resected tumours per patients of 1 (range 1-4). The procedure was completed in all the patients: mean time of 35 ± 24 minutes; the median hospital staying was 2 days(1-7).The one year recurrence-free survival was 94.2%. All the ERBT samples showed the presence of DM and the RRFF-C was 5.8% (2/34). An extraperitoneal bladder perforation occurred in only one patient, who was managed by conservative approach (catheterization), two patients developed fever; no significant haematuria was recorded.
Our findings confirmed the feasibility and safety of thullium laser en-bloc resection of NMIBC with favorable preliminary results.