| Objective: To assess the clinical safety and efficacy of holmium laser resection of superficial bladder cancer compared with standard transurethral resection of bladder cancer. To observe the effect of Ho: YAG laser enlarged vaporization of bladder cancer peripheral mucosa on cancer recurrence rate.Methods: 228 patients were assigned to undergo holmium laser resec- tion of bladder cancer(HOLBT), and 50 patients underwent standard elect- rocautery transurethral resection(TURBT).The mean operative time, num- bers of transfusion, bladder perforation and obturator nerve reflection, bladder irrigation, urethra stenosis, catheterization time, , hospitalization time as well as tumor recurrence rate were recored. The HoLRBT group was divided into two subgroups. peripheral mucosa: enlarged vaporization group in term of group A (99 patients) and peripheral mucosa non-enlarged vapo- rization group in term of B (126 patients) Pre-, intra-, and post- operative details mentioned above were recorded as well.Results: The follow up time of group A was 13 to 126 months (mean 99 months). The two-year recurrence rate was 15.8% including 4.0% in field recurrence. The five-year recurrence rate was 33.1%, including 3.5% in field recurrence and ten-year recurrence rate was 35.0% including 3.9% in field recurrence. The follow up time of group B was 10 to 120 months (mean 95 months). The two-year-recurrence rate was 16.2%, including 6.0% in field recurrence. The five-year recurrence rate was 37.6% including 4.5% in field recurrence and ten-year recurrence rate was 39.5% including 5.3% in field recurrence. The followed up time of TURBT group was 13 to 131 months (mean 99 months). The two-year recurrence rate was 24.5% including 14.0% in field recurrence. The five-year recurrence rate was 47.6% including 7.7% in field recurrence and ten-year recurrence rate was 42.5% including 13.0% in field recurrence.There were no significant differences in tumor status among the three groupsn no significant difference in the efficacy of THP(Pirarubicin), MMC (Mitomycin), BCG(Bacillus Calmette-Guerin) instillation after opera- tion(P> 0.05). There was significant difference in the average blood loss, incidence rate of obturator nerve reflection, catheterization time, the time of postoperative bladder irrigation and hospital stay, and the rate of urinary tract infection in A group and B group compare to TURBT group (P<0.01). There was no significant difference between group A and group B in mean time operation, the efficacy of THP etc. instillation after operation, blood loss in operation, in-dwelling urethral catheter time, in-dwelling urethral catheter time, hospital stay after operation (P>0.05). There is no significant difference among the three groups in two-year recurrence rate, five-year recurrence rate and ten-year recurrence rate (P>0.05);in A group and B group there is significant difference in the second year field recur- rence, the fifth year field recurrence, the second year field recurrence (P<0.05), There is no significant difference in the tenth year field recur- rence rate (P>0.05) in A group and TURBT group , there is significant difference about the second year field recurrence rate, the fifth year field recurrence rate (P<0.05), There is no significant difference in the tenth year field recurrence (P>0.05); There is no significant difference in the second year field recurrence, the fifth year field recurrence, the tenth year field recurrence in B group and TURBT group (P>0.05).Conclusion: Ho: YAG laser is a simple, safe, effective alternative in treating superficial bladder cancer compared to TURBT with fewer peri- operative complications, less abtainment of adverse side effect and recov- ering time, lower recurrence-free survival particularly for high risk patients. Our single-center experiences have shown that HOLRBT and enlarged vapo- rization of bladder cancer peripheral mucosa results in significant lower recurrence-free survival than TURBT. |
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