Safety and Short-Term Oncological Outcomes of Thulium Fiber Laser en Bloc Resection of Non-Muscle-Invasive Bladder Cancer: A Prospective Non-Randomized Phase II Trial

Dmitry Enikeev, Mark Taratkin, Vitaly Margulis, Nikolay Sorokin, Lubov Severgina, Nina Paramonova, Dmitry Kislyakov, Vasiliy Kozlov, Leonid Rapoport, Shahrokh F. Shariat, Petr Glybochko

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Abstract

BACKGROUND: Ongoing efforts aim at overcoming the challenges of conventional transurethral resection of bladder tumor (TURBT) such as the high recurrence rate, difficulty of pathologic interpretation and complications including wall injury. OBJECTIVE: To prospectively assess the safety and efficacy of Thulium fiber en bloc resection of bladder tumor (Tm-fiber ERBT) compared to TURBT. MATERIALS AND METHODS: The prospective non-randomized study included 129 patients with non-muscle-invasive bladder cancer (NMIBC) divided into two groups: 58 patients underwent conventional TURBT and 71 -Tm-fiber ERBT with FiberLase U1 (NTO IRE-Polus, Russia). Relapse-free survival (RFS), detrusor presence and complication rates were assessed. For multivariable analysis we used the Pearson chi-squared Hosmer-Lemeshow goodness of fit test; to compare survival -Cox regression analysis; for operative data comparison -chi-square test with Fisher's correction; for survival analysis -the Kaplan-Meier method and logrank test. RESULTS: RFS rates at 3 and 6 months were 84.5% and 67.2% for conventional TURBT versus 97.2% and 91.5% for Tm-fiber ERBT (p = 0.011 and p < 0.001, respectively). Detrusor muscle was present in 58.6% of cases treated with conventional TURBT vs 91.6% for the Tm-fiber ERBT group (p < 0.001). The obturator nerve reflex and bleeding were noted in 17.2% and 10.3% of TURBT cases, respectively; and in none of cases treated with Tm-fiber ERBT. Limitations included the non-randomized nature and the small sample size. CONCLUSIONS: Tm-fiber ERBT seems to be a safe and efficacious treatment option for NMIBC. Tm-fiber ERBT had fewer adverse events, was more likely to secure detrusor muscle in the specimen and resulted in better RFS rates than conventional TURBT. Based on these promising data, we have started a prospective randomized clinical trial comparing en bloc TURBT with conventional TURBT (ClinicalTrials.gov NCT03718754).

Original languageEnglish (US)
Pages (from-to)201-210
Number of pages10
JournalBladder Cancer
Volume6
Issue number2
DOIs
StatePublished - 2020

Keywords

  • Bladder cancer
  • en bloc resection
  • thulium fiber laser
  • transurethral resection

ASJC Scopus subject areas

  • Oncology
  • Urology

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    Enikeev, D., Taratkin, M., Margulis, V., Sorokin, N., Severgina, L., Paramonova, N., Kislyakov, D., Kozlov, V., Rapoport, L., Shariat, S. F., & Glybochko, P. (2020). Safety and Short-Term Oncological Outcomes of Thulium Fiber Laser en Bloc Resection of Non-Muscle-Invasive Bladder Cancer: A Prospective Non-Randomized Phase II Trial. Bladder Cancer, 6(2), 201-210. https://doi.org/10.3233/BLC-200275