Mario W Kramer1, Jens J Rassweiler2, Jan Klein2, Alexey Martov3, Nikolay Baykov3, Lukas Lusuardi4, Günter Janetschek4, Rodolfo Hurle5, Mathias Wolters1, Mahmoud Abbas6, Christoph A von Klot1, Armin Leitenberger7, Markus Riedl7, Udo Nagele8, Axel S Merseburger1, Markus A Kuczyk1, Marko Babjuk9, Thomas R W Herrmann10. 1. Department of Urology and Urological Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. 2. Department of Urology, SLK Kliniken Heilbronn, Heilbronn, Germany. 3. Department of Urology, Russian Medical Postgraduate Academy, Moscow City Hospital No. 57, Moscow, Russia. 4. Department of Urology, Medical University Salzburg, Salzburg, Austria. 5. Department of Urology, Humanitas Research Hospital, Milan, Italy. 6. Institute of Pathology, Hannover Medical School, Hannover, Germany. 7. Department of Urology, Hospital of Wolfsburg, Wolfsburg, Germany. 8. Department of Urology and Andrology, TILAK General Hospital Hall, Hall in Tyrol, Austria. 9. Department of Urology, Hospital Motol, Second Faculty of Medicine, Charles University, Prague, Czech Republic. 10. Department of Urology and Urological Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. herrmann.thomas@mh-hannover.de.
Abstract
PURPOSE: En bloc resection of bladder tumors (ERBT) may improve staging quality and perioperative morbidity and influence tumor recurrence. This study was designed to evaluate the safety, efficacy, and recurrence rates of electrical versus laser en bloc resection of bladder tumors. METHODS: This European multicenter study included 221 patients at six academic hospitals. Transurethral ERBT was performed with monopolar/bipolar current or holmium/thulium laser energy. Staging quality measured by detrusor muscle involvement, various perioperative parameters, and 12-month follow-up data was analyzed. RESULTS: Electrical and laser ERBT were used to treat 156 and 65 patients, respectively. Median tumor size was 2.1 cm; largest tumor was 5 cm. Detrusor muscle was present in 97.3 %. A switch to conventional TURBT was significantly more frequent in the electrical ERBT group (26.3 vs. 1.5 %, p < 0.001). Median operation duration (25 min), postoperative irrigation (1 day), catheterization time (2 days), and hospitalization (3 days) were similar. Overall complication rate was low (Clavien ≥ 3, n = 6 [2.7 %]). Hemoglobin was significantly lower after electrical ERBT (p = 0.0013); however, overall hemoglobin loss was not clinically relevant (0.38 g/dl). Patients (n = 148) were followed for 12 months; 33 (22.3 %) had recurrences. In total, 63.6 % recurrences occurred outside the ERBT resection field. No difference was noted between ERBT groups. CONCLUSIONS: ERBT is safe and reliable regardless of the energy source and provides high-quality resections of tumors >1 cm. Recurrence rates did not differ between groups, and the majority of recurrences occurred outside the ERBT resection field.
PURPOSE: En bloc resection of bladder tumors (ERBT) may improve staging quality and perioperative morbidity and influence tumor recurrence. This study was designed to evaluate the safety, efficacy, and recurrence rates of electrical versus laser en bloc resection of bladder tumors. METHODS: This European multicenter study included 221 patients at six academic hospitals. Transurethral ERBT was performed with monopolar/bipolar current or holmium/thulium laser energy. Staging quality measured by detrusor muscle involvement, various perioperative parameters, and 12-month follow-up data was analyzed. RESULTS: Electrical and laser ERBT were used to treat 156 and 65 patients, respectively. Median tumor size was 2.1 cm; largest tumor was 5 cm. Detrusor muscle was present in 97.3 %. A switch to conventional TURBT was significantly more frequent in the electrical ERBT group (26.3 vs. 1.5 %, p < 0.001). Median operation duration (25 min), postoperative irrigation (1 day), catheterization time (2 days), and hospitalization (3 days) were similar. Overall complication rate was low (Clavien ≥ 3, n = 6 [2.7 %]). Hemoglobin was significantly lower after electrical ERBT (p = 0.0013); however, overall hemoglobin loss was not clinically relevant (0.38 g/dl). Patients (n = 148) were followed for 12 months; 33 (22.3 %) had recurrences. In total, 63.6 % recurrences occurred outside the ERBT resection field. No difference was noted between ERBT groups. CONCLUSIONS:ERBT is safe and reliable regardless of the energy source and provides high-quality resections of tumors >1 cm. Recurrence rates did not differ between groups, and the majority of recurrences occurred outside the ERBT resection field.
Entities:
Keywords:
Bladder cancer; En bloc; Holmium; Laser; TURBT; Thulium
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Authors: Mathias Wolters; Mario W Kramer; Jan U Becker; Matthias Christgen; Udo Nagele; Florian Imkamp; Martin Burchardt; Axel S Merseburger; Markus A Kuczyk; Thorsten Bach; Andreas J Gross; Thomas R W Herrmann Journal: World J Urol Date: 2011-05-08 Impact factor: 4.226