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Green‐light laser en bloc resection versus conventional transurethral resection for initial non‐muscle‐invasive bladder cancer: A randomized controlled trial
Author(s) -
Fan Jinhai,
Wu Kaijie,
Zhang Nan,
Yang Tao,
Liu Nan,
Jiang Yumei,
Bai Xiaojing,
Wang Xinyang,
He Dalin
Publication year - 2021
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.14592
Subject(s) - medicine , obturator nerve , resection , bladder cancer , surgery , randomized controlled trial , perioperative , pathological , urology , cancer
Objective To compare the safety and outcomes between green‐light laser en bloc resection and transurethral resection of bladder tumor. Methods A single‐center, randomized controlled trial was carried out from August 2014 to September 2018. Patients with initial non‐muscle‐invasive bladder cancer were randomized to green‐light laser en bloc resection or transurethral resection of bladder tumor. The primary outcomes were pathological findings and perioperative events. The secondary outcome was tumor recurrence. Results A total of 233 patients were randomized to the transurethral resection of bladder tumor group (117 patients) and the green‐light laser en bloc resection group (116 patients). The resection time was longer in the green‐light laser en bloc resection group ( P = 0.022); however, no differences were identified in overall operative time ( P = 0.255). Nine patients (7.7%) had an obturator nerve reflex during transurethral resection of bladder tumor. The estimated volume of blood loss was significantly lower in the green‐light laser en bloc resection group ( P = 0.012). The green‐light laser en bloc resection group had a higher rate of T1 bladder cancer ( P = 0.031). A total of 104 patients (89.7%) treated with green‐light laser en bloc resection had detrusor muscle presence in the specimen, whereas 37 (31.9%) patients had the presence of muscularis mucosae, which was significantly higher than the corresponding number of transurethral resection of bladder tumor patients ( P = 0.005 and 0.002, respectively). After a median follow‐up period of 48 months, just five patients had tumor recurrence (three in the transurethral resection of bladder tumor group and two in the green‐light laser en bloc resection group), and there was no difference between these two groups. Conclusions Compared with transurethral resection of bladder tumor, green‐light laser en bloc resection is more effective due to less obturator nerve reflex and the same recurrence rate. Most importantly, green‐light laser en bloc resection can provide better tumor specimens for pathological examinations.