Blue vs white light for transurethral resection of non‐muscle‐invasive bladder cancer: an abridged Cochrane Review

Abstract

Objectives To assess the effects of blue‐light (BL)‐enhanced transurethral resection of bladder tumour (TURBT) compared to white‐light (WL)‐based TURBT in the treatment of non‐muscle‐invasive bladder cancer (NMIBC). Methods Based on a published protocol, we performed a systematic search of multiple databases from their inception to March 2021. We included randomized controlled trials (RCTs) comparing blue‐light (BL) TURBT to white‐light (WL) TURBT. Our meta‐analysis was based on a random‐effects model. We assessed the quality of evidence on a per‐outcome basis according to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Results We included 16 RCTs involving a total of 4325 participants in this review. BL TURBT may reduce the risk of disease recurrence over time (hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.54–0.81; low‐certainty evidence) depending on baseline risk. For participants with low‐, intermediate‐ and high‐risk NMIBC, this corresponded to 48 (66 fewer to 27 fewer), 109 (152 fewer to 59 fewer) and 147 (211 fewer to 76 fewer) fewer recurrences per 1000 participants when compared to WL TURBT, respectively. BL TURBT may also reduce the risk of disease progression over time (HR 0.65, 95% CI 0.50–0.84; low‐certainty evidence) depending on baseline risk. For participants with low‐, intermediate‐ and high‐risk NMIBC, this corresponded to 1 (1 fewer to 0 fewer), 17 (25 fewer to 8 fewer), and 56 (81 fewer to 25 fewer) fewer progressions per 1000 participants when compared to WL TURBT, respectively. Conclusions Our findings suggest a favourable impact of BL TURBT on the risk of disease recurrence and progression; however, whether this risk reduction is clinically relevant greatly depends on the baseline risk of patients. We did not find an increase in severe surgical complications with BL cystoscopy, and we did not find any trial evidence on other, non‐surgical adverse events.

Poor Prognosis With Intravesical Bacillus Calmette-Guérin History After Photodynamic Diagnosis-assisted Transurethral Resection Using 5-Aminolevulinic Acid

“…PDD-assisted TURBT using ALA is becoming increasingly popular in Japan, and its usefulness has been reported in several studies (3,4,6,7). Moreover, several recent systematic reviews revealed that TURBT with PDD could reduce BC recurrence and resulted in a progression risk reduction compared to conventional TURBT with WL (13)(14)(15). This retrospective study found that FL had significantly higher sensitivity and lower specificity than WL, similar to previous reports (5,16).…”

Framework for a living systematic review and meta-analysis for the surgical treatment of bladder cancer: introducing EVIglance to urology

“… 36 , Krajewski et al . 37 ); Photodynamic diagnosis versus white light TURBT (Kausch et al 38 , Maisch et al 39 , Veeratterapillay et al 40 ). …”

Recurrence of non-muscle invasive bladder carcinoma after transurethral resection with hexaminolevulinate photodynamic diagnosis or regular cystoscopy

“…A meta-analysis by Chou in 2017 showed that the use of hexaminolevulinate had a significant effect on recurrence [9]. In 2022, Maisch published a Cochrane review, which suggests favourable impact on recurrence in medium-to high-risk subgroups [10]. Most reviews published have reported the quality of evidence to be low, mainly because of heterogeneity (e.g.…”

“…trials included both new and recurrent carcinoma), lack of treatment standardisation (e.g. intravesical chemotherapy) and lack of subgroup analysis [7][8][9][10][11]. Nevertheless, despite the inconclusive reports, PDD has been introduced in clinical care.…”