V8-08: Laser en bloc resection of bladder tumors: a European multi-center study to evaluate safety, efficacy and outcome

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Introductions and Objectives
Despite conventional TURBT being the gold standard, en bloc resection of bladder tumors (ERBT) has been shown to be a valuable alternative. One major goal of ERBT is to enhance staging quality by avoiding tissue fragmentation and increasing the rate of detrusor muscle. The objective of this multi-center study was to evaluate safety, efficacy and recurrence rates of patients treated by laser ERBT of non-muscle invasive bladder tumors.

Methods
Three academic hospitals provided prospectively collected data of patients treated by laser ERBT. Patients´ characteristics, clinical and pathologic data were assessed. Complications were recorded using the Clavien-Dindo classification. Laser en bloc resection was carried out either with a Thulium:YAG (Tm:YAG) or a Holmium:YAG (Ho:YAG) laser. Surgical procedures were performed in a similar fashion by all study centers. Follow-up was carried out based on EAU guidelines.

Results
The results are displayed in Table 1. Sixty-five patients were treated by laser ERBT between June 2010 to April 2014. Pathological evaluations revealed 39 patients with pTa and 26 patients with pT1 tumors. All specimens included detrusor muscle, edges were free of tumor in all cases and 100% of biopsies from the tumor ground were negative. One operation was switched to conventional transurethral resection. Only 3 (4.6%) complications ≥3 were recorded. No obturator nerve reflex appeared. Fifty-four patients with primary urothelial carcinoma of the bladder and a minimum follow-up of 12 months revealed a cumulative recurrence rate of 18.5% after a follow-up of one year. Recurrences within the former resection area were noticed in only 2 of 10 patients.

Conclusions
Laser en bloc resection of bladder tumors has been proven safe and effective for the treatment and pathological staging of non-muscle invasive bladder cancer. Lasers might also be an alternative for patients with higher risk of bleeding due to its effective hemostatic properties. In-field recurrences seem to be decreased.

Funding: none