Long‐term outcomes of outpatient laser ablation for recurrent non‐muscle invasive bladder cancer: A retrospective cohort study

Abstract

Objectives The objective of this study is to determine the long‐term efficacy and safety of office‐based Holmium:YAG laser ablation for the treatment of recurrent non‐muscle‐invasive bladder cancer (NMIBC). Methods We retrospectively reviewed the medical records of all consecutive patients who underwent office‐based laser ablation for recurrent bladder cancer between 2008 and 2016. The following data were collected: original histology, date of original histology, date of laser ablation, number of repeat laser ablation procedures required, date of tumor recurrence or progression, number of general anesthesia procedures (transurethral resection or cystodiathermy) required after first laser ablation, and number and severity of complications. Kaplan–Meier survival curves were produced for recurrence‐free survival, progression‐free survival, and overall survival. Results A total of 97 patients, with an average age of 84 (62–98) years and an average Charlson Comorbidity Index of 6.9 (4–13), were included. The median follow‐up was 61 (2–150) months. Fifty‐five (56.7%) patients presented with tumor recurrence, and the median recurrence‐free survival time was 1.69 years (95% CI 1.20–2.25). Only 9 (9.3%) patients had evidence of tumor progression to a higher grade or stage, 8 (89%) of which initially had low‐grade tumors; however, no patient progressed to muscle‐invasive disease. The median progression‐free survival time was 5.70 years (95% CI 4.10–7.60), and the median overall survival time was 7.60 years (95% CI 4.90–8.70). No patient required emergency inpatient admission after laser ablation. Conclusion Office‐based Holmium:YAG laser ablation offers a safe and effective alternative method for treating low‐volume, low‐grade recurrent NMIBC, especially in elderly patients with significant co‐morbidity, while avoiding general anesthesia and inpatient admission.

Adapting to the long pandemic

“…Of course, many complications reported are isolated incidents or case reports, so not much opportunity for statistical statements. Their discussion/recommendations note the array of complications parents should be aware of when making a decision and that use of experienced providers with sterile settings can help. To the Clinic… The study by Grover et al 2 points out that low‐grade bladder cancer is the most common form of bladder cancer and has high rates of recurrences and operative interventions that drive significant healthcare costs, especially from repeat general anaesthetics. They report on an alternative approach to the standard TURBT in which 97 patients with advanced age and/or comorbid conditions were selected for an office‐based ablation with a laser.…”

“…To the Clinic… The study by Grover et al 2 points out that low-grade bladder cancer is the most common form of bladder cancer and has high rates of recurrences and operative interventions that drive significant healthcare costs, especially from repeat general anaesthetics.…”

Macrophage activity at the site of tumor ablation can promote murine urothelial cancer via transforming growth factor-β1

“…Urothelial cancer in the bladder and upper urinary tract is diagnosed at an early and localized stage in more than 70% of patients with the disease for whom preference is given to urinary function sparing focal therapies. Urothelial tumors are treated by ablation using laser, electrocautery fulguration or photodynamic therapy (1)(2)(3)(4). Local tumor recurrence is commonly observed in these patients (1,2,5).…”

“…Urothelial tumors are treated by ablation using laser, electrocautery fulguration or photodynamic therapy (1)(2)(3)(4). Local tumor recurrence is commonly observed in these patients (1,2,5). The etiology of recurrence is not well understood where the relative contribution of incomplete tumor ablation and disease characteristics has not been delineated.…”

The Role of NMP22 and CSTB Levels in Predicting Postoperative Recurrence of Bladder Cancer

“…Bladder cancer is a malignant tumor of the bladder mucosa. It is considered to be one of the ten most common malignant tumors, and its incidence is second only to prostate cancer, ranking second [ 1 , 2 ]. The disease can occur at any age, even in children.…”