Photodynamic diagnosis-assisted en bloc transurethral resection of bladder tumor for non-muscle invasive bladder cancer: short-term oncological and functional outcomes

Bladder Cancer
17/09/2020

J Endourol. 2020 Sep 17. doi: 10.1089/end.2020.0371. Online ahead of print.

ABSTRACT

<i>Background:</i> We describe the oncological and functional outcomes and the surgical technique of the photodynamic diagnosis (PDD)-assisted en bloc transurethral resection of bladder tumor (TURBT) using a rectangular cutting loop. <i>Patients and Methods: </i>We reviewed 40 patients with carcinoma in situ-free non-muscle invasive bladder cancer undergoing PDD-TURBT. Of 40 patients, 12 underwent PDD-EBTUR and 28 underwent PDD-conventional TURBT (cTURBT). Two groups were matched in terms of clinicopathological background and did not include patients treated with intravesical Bacillus Calmette-Guerin. The assessment of postoperative quality of life (QOL) was based on patient-reported outcome measure, including the International Prostate Symptom Score, Functional Assessment of Cancer Therapy-Bladder (FACT-BL), and SF-8 questionnaires before and 1 month after TUR. <i>Results: </i>PDD guidance provided substantial help for circumferent demarcation around the bladder tumor, which precedes tumor dissection. One female patient (12%) treated by PDD-EBTUR had grade II bladder perforation requiring prolonged catheterization. Pathological assessment of horizontal and vertical margins in resected specimens by PDD-EBTUR revealed that all specimens had muscularis propria and the rate of en bloc resection was 100%. No patient had intravesical recurrence in the PDD-EBTUR group (median follow-up, 11 months), while two patients in the PDD-cTURBT group had Ta low-grade recurrent tumors (8 months). Postoperatively, scores of daytime frequency and nocturia were increased in both groups. QOL assessment using the FACT-BL and SF-8 revealed that postoperative deterioration of bladder-specific subscale and emotional/mental scores was found in the EBTUR group but not in the cTURBT group. <i>Conclusions:</i> Based on the initial experience on 12 patients, we considered that PDD-EBTUR is an acceptable surgical method. Further experience and research are mandatory to determine whether this technique yields better outcomes and has true clinical advantage.