| BACKGROUND:To evaluate the effectiveness and feasibility of treating primary non muscle invasive bladder cancer(NMIBC) with 2-μm continuous-wave(CW) thulium laser. METHODS:Form 2006.1 to 2010.12, we enrolled and randomly assigned 400 consecutive patients newly diagnosed with clinical stage Ta or T1 bladder cancer in our hospital into TURBT or laser vaporesection(TULVBT) treatment groups. Patients in TURBT group accepted standard transurethral resection with bipolar electrocautery system and patients in TULVBT group accepted transurethral vaporesction with 2-μm CW thulium laser. In TULVBT group, patients needed to accept an additional cystoscopic biopsy on bladder muscle for separate histopathology after tumors vaporsected by 2-μm CW thulium laser and superficial cauterized tissue of the base was swept off. Re-TURBT needed to perform 3-4 weeks after initial endoscopic operation for those with suspected tumor residue or absence of muscle information in histopathology after initial procedure. Cystoscopy was performed every 3 months in the first 2 years following with every 6 months. RESULTS:292 patients were included in our analysis, 143 to receive TURBT and 149 to receive TULVBT. TURBT was significantly superior to TULVBT in terms of operation time(28.43±13.19 vs 31.51±12.80 minutes, P=0.044). Among 44 patients(17 in TURBT and 27 in TULVBT, P=0.137) who had to accept Re-TURBT, 27 patients were because of absence of detrusor muscle, 9(6.3%) in TURBT group and 18(12.1%) in TULVBT group(P=0.088). During 36 months follow-up, 129 cases(44.2%) was detected tumor recurrence, 61(42.7%) in TURBT and 68 cases(45.6%) in TULVBT(P=0.608). 19 patients(6.5%) found tumor progression, 11 in TURBT(7.7%) and 8(5.4%) in TULVBT(P=0.421). Average tumor free survival time was 25.16±12.99 months(25.46±13.18 in TURBT vs 24.88±12.85 in TULVBT, P=0.729). CONCLUSIONS:2-μm CW thulium laser could be used to treat primary NMIBC. Combing with repeat cystoscopic biopsy during operation, 2-μm CW laser could provide sufficient diagnostic and prognostic information, having similar effect as TURbt. |
