Tumor margin demarcation during partial cystectomy for bladder cancer is difficult, with no standard approach in place, according to a report, published in BMC Cancer. The report’s authors, led by Kang Sup Kim, reported their initial experience with a holmium laser-assisted method for tumor demarcation, which they stated was an “effective and safe technique in carefully selected patients.”
Between Match 2016 and February 2019, investigators enrolled patients from their institution who had elected for a partial cystectomy for bladder cancer. To be included, patients had to have disease stage T2 or T3 and tumor location restricted within the dome and the lateral and posterior side of the bladder. The laparoscopic surgeries included holmium laser-guided mucosal incisions down to the perivesical fat, with minimal safety margins of 5 to 10 mm.
Kim and colleagues utilized the holmium laser-assisted technique on 10 patients undergoing laparoscopic partial cystectomy. Tumors were located laterally in seven patients, in the dome in two patients, and in the posterior wall in one patient. Reportedly, “pathological examination of surgical margin showed no cancer cell involvement in all cases,” they wrote. Lastly, there were no recurrences or metastases among the patients over 12 months of follow-up.
Overall, the study’s authors assigned favorable safety and efficacy profiles to the holmium laser-assisted approach to tumor margin demarcation in carefully selected partial cystectomy patients. Kim and colleagues closed the report with the summary that “holmium laser resection provides a feasible and safe method,” for precise and appropriate demarcation “that assists in bladder incision with minimal ureteral orifice involvement.”