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Safety and efficacy of thulium laser resection of bladder tumors versus transurethral resection of bladder tumors: a systematic review and meta-analysis

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Abstract

The thulium laser resection of bladder tumor (TmLRBT) is widely used in the treatment of non-muscle-invasive bladder cancer (NMIBC), and we conduct this study to compare the safety and efficacy of TmLRBT with transurethral resection of bladder tumor (TURBT). A comprehensive literature research was conducted using multiple databases, and comparative studies evaluating the safety and efficacy of TmLRBT and TURBT were included. For continuous outcomes, the weighted mean difference (WMD) was used to measure the difference, whereas the risk ratio (RR) with a 95% confidence interval (CI) was calculated for binary variables. Overall, ten studies with 1558 patients enrolled were included in the meta-analysis. The baseline characteristics of two groups were comparable. The operative time (p = 0.24) and catheterization time (p = 0.41) of two groups were similar but the TmLRBT group had a shorter length of hospital stay (p = 0.04). TmLRBT was related to fewer intraoperative complications including obturator nerve reflex (p < 0.001) and bladder perforation (p < 0.001). Although the rate of postoperative irrigation did not significantly differ in our analysis (p = 0.28), the TmLRBT was related to a significantly shorter duration of irrigation (p = 0.004). Besides, the TmLRBT group had a higher rate of identification of detrusor (p = 0.02). However, TmLRBT did not suggest significantly better cancer control than TURBT including the overall recurrence (p = 0.052), 1-year recurrence (p = 0.23), and 2-year recurrence (p = 0.40). Compared with conventional TURBT, the TmLRBT showed superior safety and non-inferior efficacy in cancer control. TmLRBT could also provide high-quality specimens for pathology diagnosis; therefore, it is an as effective option for NMIBC.

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References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424. https://doi.org/10.3322/caac.21492

    Article  PubMed  Google Scholar 

  2. Cumberbatch MGK, Jubber I, Black PC, Esperto F, Figueroa JD, Kamat AM et al (2018) Epidemiology of bladder cancer: a systematic review and contemporary update of risk factors in 2018. Eur Urol 74(6):784–795. https://doi.org/10.1016/j.eururo.2018.09.001

    Article  PubMed  Google Scholar 

  3. Babjuk M, Burger M, Compérat EM, Gontero P, Mostafid AH, Palou J et al (2019) European Association of Urology guidelines on non-muscle-invasive bladder cancer (TaT1 and Carcinoma In Situ)-2019 Update. Eur Urol 76(5):639–657. https://doi.org/10.1016/j.eururo.2019.08.016

    Article  CAS  PubMed  Google Scholar 

  4. Johnson DE, Cromeens DM, Price RE (1992) Use of the holmium:YAG laser in urology. Lasers Surg Med 12(4):353–363. https://doi.org/10.1002/lsm.1900120402

    Article  CAS  PubMed  Google Scholar 

  5. Johnson DE (1994) Use of the holmium:YAG (Ho:YAG) laser for treatment of superficial bladder carcinoma. Lasers Surg Med 14(3):213–218. https://doi.org/10.1002/lsm.1900140303

    Article  CAS  PubMed  Google Scholar 

  6. Li C, Gao L, Zhang J, Yang X, Liu C (2020) The effect of holmium laser resection versus standard transurethral resection on non-muscle-invasive bladder cancer: a systematic review and meta-analysis. Lasers Med Sci. https://doi.org/10.1007/s10103-020-02972-w

  7. Xia SJ, Zhang YN, Lu J, Sun XW, Zhang J, Zhu YY et al (2005) Thulium laser resection of prostate-tangerine technique in treatment of benign prostate hyperplasia. Zhonghua Yi Xue Za Zhi 85(45):3225–3228

    PubMed  Google Scholar 

  8. Gao X, Ren S, Xu C, Sun Y (2008) Thulium laser resection via a flexible cystoscope for recurrent non-muscle-invasive bladder cancer: initial clinical experience. BJU Int 102(9):1115–1118. https://doi.org/10.1111/j.1464-410X.2008.07814.x

    Article  PubMed  Google Scholar 

  9. Wendt-Nordahl G, Huckele S, Honeck P, Alken P, Knoll T, Michel MS et al (2008) Systematic evaluation of a recently introduced 2-microm continuous-wave thulium laser for vaporesection of the prostate. J Endourol 22(5):1041–1045. https://doi.org/10.1089/end.2007.0421

    Article  PubMed  Google Scholar 

  10. Bach T, Wendt-Nordahl G, Michel MS, Herrmann TR, Gross AJ (2009) Feasibility and efficacy of thulium:YAG laser enucleation (VapoEnucleation) of the prostate. World J Urol 27(4):541–545. https://doi.org/10.1007/s00345-008-0370-0

    Article  CAS  PubMed  Google Scholar 

  11. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097

    Article  PubMed  PubMed Central  Google Scholar 

  12. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I et al (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366:l4898. https://doi.org/10.1136/bmj.l4898

    Article  PubMed  Google Scholar 

  13. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919. https://doi.org/10.1136/bmj.i4919

    Article  PubMed  PubMed Central  Google Scholar 

  14. McGuinness LA, Higgins JPT (2021) Risk-of-bias VISualization (robvis): an R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods 12(1):55-61. https://doi.org/10.1002/jrsm.1411

  15. Chen X, Liao J, Chen L, Qiu S, Mo C, Mao X et al (2015) En bloc transurethral resection with 2-micron continuous-wave laser for primary non-muscle-invasive bladder cancer: a randomized controlled trial. World J Urol 33(7):989–995. https://doi.org/10.1007/s00345-014-1342-1

    Article  CAS  PubMed  Google Scholar 

  16. Huang JH, Hu YY, Liu M, Wang GC, Peng B, Yao XD (2016) Comparative study of 2 um laser versus holmium laser for the resection of non-muscle invasive bladder cancer. Int J Clin Exp Med 9(12):23618–23623

    Google Scholar 

  17. Liao J, Chen X, Chen Z, Chen L, Li X, Chen J (2015) Feasibilty and safety of en bloc transurethral resection with thulium-Yag laser in the management of patients with non-muscle-invasive bladder cancer. Tumor 35(7):788–793

    Google Scholar 

  18. Liu H, Wu J, Xue S, Zhang Q, Ruan Y, Sun X et al (2013) Comparison of the safety and efficacy of conventional monopolar and 2-micron laser transurethral resection in the management of multiple nonmuscle-invasive bladder cancer. J Int Med Res 41(4):984–992. https://doi.org/10.1177/0300060513477001

    Article  CAS  PubMed  Google Scholar 

  19. Liu Y, Lu J, Xiao C (2013) Comparison between 2-mum continuous-wave thulium laser and transurethral resection for non-muscle-invasive bladder cancer: a retrospective comparative study. Chin J Minim Invasive Surg 13(1):23–28

    Google Scholar 

  20. Migliari R, Buffardi A, Ghabin H (2015) Thulium laser endoscopic en bloc enucleation of nonmuscle-invasive bladder cancer. J Endourol 29(11):1258–1262. https://doi.org/10.1089/end.2015.0336

    Article  PubMed  Google Scholar 

  21. Xu H, Ma J, Chen Z, Yang J, Yuan H, Wang T et al (2018) Safety and efficacy of en bloc transurethral resection with 1.9 microm vela laser for treatment of non-muscle-invasive bladder cancer. Urology 113:246–250. https://doi.org/10.1016/j.urology.2017.11.030

    Article  PubMed  Google Scholar 

  22. Zhang XR, Feng C, Zhu WD, Si JM, Gu BJ, Guo H et al (2015) Two micrometer continuous-wave thulium laser treating primary non-muscle-invasive bladder cancer: is it feasible? a randomized prospective study. Photomed Laser Surg 33(10):517–523. https://doi.org/10.1089/pho.2015.3913

    Article  CAS  PubMed  Google Scholar 

  23. Zhong C, Guo S, Tang Y, Xia S (2010) Clinical observation on 2 micron laser for non-muscle-invasive bladder tumor treatment: single-center experience. World J Urol 28(2):157–161. https://doi.org/10.1007/s00345-010-0532-8

    Article  PubMed  Google Scholar 

  24. Sorokin NI, Enikeev DV, Dymov AM, Tsarichenko DG, Kislyakov DA, Gololobov GY et al (2018) Safety and efficacy of thulium transurethral en block resection with fiber laser “Urlaz” for treatment of non-muscle-invasive bladder cancer. Onkourologiya 14(1):144–151. https://doi.org/10.17650/1726-9776-2018-14-1-144-151

    Article  Google Scholar 

  25. Khorrami MH, Javid A, Saryazdi H, Javid M (2010) Transvesical blockade of the obturator nerve to prevent adductor contraction in transurethral bladder surgery. J Endourol 24(10):1651–1654. https://doi.org/10.1089/end.2009.0659

    Article  PubMed  Google Scholar 

  26. Liang JH, Pan YL, Kang J, Qi J (2012) Influence of irrigation on incision and coagulation of 2.0-μm continuous-wave laser: an ex vivo study. Surg Laparosc Endosc Percutan Tech 22(3):e122–e125. https://doi.org/10.1097/SLE.0b013e318248b69e

    Article  PubMed  Google Scholar 

  27. Hafner C, Knuechel R, Zanardo L, Dietmaier W, Blaszyk H, Cheville J et al (2001) Evidence for oligoclonality and tumor spread by intraluminal seeding in multifocal urothelial carcinomas of the upper and lower urinary tract. Oncogene 20(35):4910–4915. https://doi.org/10.1038/sj.onc.1204671

    Article  CAS  PubMed  Google Scholar 

  28. Blaschke S, Koenig F, Schostak M (2016) Hematogenous tumor cell spread following standard transurethral resection of bladder carcinoma. Eur Urol 70(3):544–545. https://doi.org/10.1016/j.eururo.2016.03.051

    Article  PubMed  Google Scholar 

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Funding

This work is supported by the Natural Science Fund of Hubei Province (Grant Number: 2018CFB459, Recipient: Dr. Heng Li).

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Supplementary Figure 1

Risk of bias graph of randomized studies assessed with the RoB 2 tool. (PNG 1033 kb).

High resolution image (TIF 4119 kb).

Supplementary Figure 2

Risk of bias graph of non-randomized studies assessed with the ROBINS- I tool. (PNG 1018 kb).

High resolution image (TIF 4057 kb).

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Long, G., Zhang, Y., Sun, G. et al. Safety and efficacy of thulium laser resection of bladder tumors versus transurethral resection of bladder tumors: a systematic review and meta-analysis. Lasers Med Sci 36, 1807–1816 (2021). https://doi.org/10.1007/s10103-021-03272-7

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