Outpatient removal of low-grade noninvasive bladder tumor with laser as good as TUR in GA, study says
Denmark: Outpatient tumor removal with laser is as good as transurethral resection in general anesthesia and less burdensome to patients for the removal of recurrent low-grade Ta bladder tumor (BT), claims a recent study in European Urology.
The study further showed that patients who underwent laser photocoagulation of bladder tumors (PC-BT) experienced a better postoperative quality of life, and the frequency of minor complications was lower.
Transurethral resection (TUR) of recurrent low-grade intermediate-risk Ta bladder tumor (BT) is burdensome to patients and the health care system in general anesthesia (GA). In office-based settings, laser technologies enable treatment, reducing morbidity and costs. Considering this, Gyrithe Lynghøj Pedersen, Department of Urology, Herlev-Gentofte Hospital, Capital Region of Denmark, Denmark, and colleagues performed a prospective randomized noninferiority trial comparing 4-months recurrence-free survival following outpatient department (OPD) diode laser coagulation of bladder tumor in local anesthesia and gold standard transurethral resection of BT (TUR-BT) in general anesthesia in intermediate-risk Ta low-grade BT, and to evaluate treatment-related morbidity.
The trial was performed in the Capital Region of Denmark from 2016 to 2020. Patients with verified Ta low-grade BT recurrence were included. Randomization was done on 206 patients; 176 finished treatment and follow-up per protocol.
Comparisons were made between laser photocoagulation of bladder tumor (PC-BT) in OPD using a 980 nm diode laser and gold standard TUR-BT in GA. Both were performed with photodynamic diagnosis (PDD) guidance.
The researchers assessed four-month recurrence-free survival; the predefined inferiority criterion was set at 15%. Pain during PC-BT, postoperative complications, postoperative morbidity, and patient preference were the secondary outcomes.
The study's key findings were as follows:
· After PC-BT, four-month recurrence-free survival was 8% higher. The predefined noninferiority criterion was met.
· Pain score (1–10) during PC-BT was 2.4.
· In the transurethral resection of the bladder group, the postoperative lower urinary tract symptom score (0–100) was 13.9 points higher.
· Following TUR-BT, the frequency of minor complications was 8.1% higher after TUR-BT.
· Of the patients, 98% preferred PC-BT.
"For the removal of recurrent low-grade Ta bladder tumors, PDD-guided PC-BT in OPD is as good as TUR-BT in GA," the researchers wrote. "After PC-BT, postoperative quality of life is better, and the frequency of minor complications was lower."
Reference:
Pedersen GL, Erikson MS, Mogensen K, Rosthøj S, Hermann GG. Outpatient Photodynamic Diagnosis-guided Laser Destruction of Bladder Tumors Is as Good as Conventional Inpatient Photodynamic Diagnosis-guided Transurethral Tumor Resection in Patients with Recurrent Intermediate-risk Low-grade Ta Bladder Tumors. A Prospective Randomized Noninferiority Clinical Trial. Eur Urol. 2022 Sep 1:S0302-2838(22)02564-7. doi: 10.1016/j.eururo.2022.08.012. Epub ahead of print. PMID: 36058804.
