A Comparative Study Of Transurethral LBO Laser Resection And Electrotomy In Non-muscle Invasive Bladder Cancer

Study background and purposes:Bladder cancer is one of the most common malignant tumors in the urinary system.In 2018,according to statistics from the American Cancer Society,bladder cancer ranks fourth after prostate cancer,lung cancer and colon cancer among newly diagnosed cancer cases in the United States,which accounts for 5%?10%of male malignancies.The extent of malignancy was evaluated by bladder cancer grade.At present,the WHO grading method was mostly used.Because of the great difference in biological behavior between non-muscle invasive bladder cancer and muscle invasive bladder cancer,it is necessary to choose different treatment regimens.Surgery has been proved to be one of the most effective methods for non-muscle invasive bladder cancer.Transurethral resection of bladder cancer is considered as the gold standard for the treatment of non-muscle invasive bladder cancer.As a mature surgical method,TURBT was widely used in the treatment of non-muscle invasive bladder cancer,which was often accompanied by intraoperative and postoperative complications,such as bladder perforation,obturator nerve reflex,intraoperative and postoperative bleeding and so on.At the same time,tumor cells may be disseminated during electrotomy,and exfoliated tumor cells may lead to tumor recurrence.In addition,the heat generated by the electric excision ring during TURBT process will affect the status of the resected tissues,which has an adverse impact on the pathological diagnosis.In order to solve the above problems,many new surgical methods have been applied to the clinical treatment of bladder cancer,such as transurethral laser surgery and photodynamic therapy.Now,the commonly used transurethral laser surgery mainly includes green laser,holmium laser and thulium laser.Due to its excellent hemostatic effect and accurate cutting ability,LBO laser resection has been applied to the surgical treatment of bladder cancer.The purpose of this study was to further compare the efficacy and safety of transurethral resection of bladder cancer and LBO laser resection of bladder cancer in the treatment of non-muscle invasive bladder cancer.Methods and approaches:We retrospectively collected clinical information of patients receiving TURBT and LBO laser resection for NMIBC in the department of urology of Central Hospital of Zibo Mining Group from 2013 to 2017.A total of 136 patients were finally included in this study.Inclusion criteria were as follows:(1)diagnosed as urothelial carcinoma by color ultrasound,CT,MRI,cystoscope and biopsy;(2)according to the TNM staging system,the tumor stage was Tis,Ta or T1,namely NMIBC;(3)no absolute contraindications to surgery.Exclusion criteria were as follows:(1)patients with renal pelvis or ureteral tumors;(2)patients complicated with BPH,urethral stricture and other diseases affecting the process of surgery;(3)incomplete clinical research data.Enrolled patients were divided into LBO laser group(n=64)and TURBT group(n=72)according to different surgical methods.The measurement data in this study were expressed as mean±SD,t test was used for comparison between groups,and the categorical data were analyzed by chi-square test or Fisher exact analysis method according to data characteristics.The survival rate was analyzed by Kaplan-Meier method,and the survival curve was tested by log-rank test.All data were analyzed by SPSS 22.0 statistical software,and P<0.05 was considered statistically significant.Study results:Compared with TURBT group,LBO group had shorter operation time(24.48±6.56 vs.27.42±5.53,P=0.005)and lower postoperative hemoglobin level(0.97±0.37 vs.2.88±0.57,P<0.001).No bladder perforation and obturator nerve reflex occurred in LBO group.The urinary catheter was indwelling for 2.34±0.67 days in the LBO group and 2.67±0.73 days in the TURBT group,and the difference between them was statistically significant(P=0.006).As shown by the Kaplan-Meier curve,there was no significant difference in postoperative overall survival rate and tumor-related survival rate between the LBO group and the TURBT group.Study conclusion:Compared with transurethral bladder cancer resection,LBO laser bladder cancer resection taken less time,the patients' postoperative hemoglobin level decreases less,and there is almost no obturator nerve reflex during the operation.LBO laser resection is more favorable in perioperative safety,with fewer complications,and can remove the urethral catheter earlier after the operation.At the same time,excision of the whole tumor tissue by laser can preserve the intact tumor tissue structure,and can more accurately evaluate the tumor staging and guide the subsequent treatment.There was no significant difference in OS and CSS between the patients who received LBO laser resection and those who received TURBT.