Surgery

Biography

Biography: Ziad Al-Naieb

Abstract

Background: Th e early detection of carcinoma is very essential for the diagnosis and prognosis of a bladder cancer patient. 5-aminolevulinic acid induced fluorescence cystoscopy can detect more tumour lesions comparing to standard cystoscopy is a well-documented fact. Th e goal of our study is to assess the infl uence of fl uorescence cystoscopy using 5-AlA as a natural amino acid oral powder with the conventional delta-aminolevulinic acid (ALA) or its derivative, hexaminolevulinate (HAL, Hexvix), installation. Th e oral form of 5- ALA in clearance of other urological malignancies was evaluated. Th e possible apoptotic activities of this substance in the treatment of bladder cancer as a new option and the benefi t of oral form in detecting other urological malignancies during surgery will be outlined. Methods and results: In retrospective and prospective study, 74 patients with primary or recurrent stage Ta Tl bladder transitional cell carcinoma treated with transurethral resection were enrolled. In 15 patients (group A) the oral form of 5-ALA (5-Aminolevulinic acid (SBI-Pharma-Japan). 20 patients (Group B), we used hexaminolevulinate (HAL, Hexvix). Th irty nine patients (Group C) were taken from records as the medic Germany is not producing the 5 ALA Delta from for intravesical installation any more. Th e patients were followed using standard cystoscopy and urinary cytology. In both groups, white light and blue light were used for comparison. Th e white light DATA was categorized as C I and blue light (visible blue light with wavelength of 420 nm) as C II, Recurrence free interval was evaluated in whole groups and also for single and multiple and for primary and recurrent tumours separately. Th e median time to recurrence was 8.05 months in group A and was signifi cantly shorter than 13.54 months in group B (p=0.04, log-rank test). Conclusions: 5-Aminolevulinic acid induced fl uorescence cystoscopy used during transurethral resection reduces the early recurrence rate in stage Ta Tl bladder transitional cell carcinoma. Th is fl uorescent oral form of 5-ALA, substance can be a useful tool in the treatment of Bladder cancer by inducing apoptosis when exposing the 5-ALA loaded tumour cell to external source of energy. Th is is a new research going on in our centre to study the possible use of external energy source aft er loading the cells with 5- Aminolevulinic acid. Th e patient will take the tablet 4 hours prior to surgery and the bladder will be inspected using white/blue light to stimulate the cell to produce the Protoporphyrin IX from the loaded cells and to explore the hidden or fl at cancer cellssocancer cell will be visible up to 1 mm with this method. Th e oral form opened to us new advantages in using this technology indetecting not only bladder cancers but ureteral renal and even prostatic malignancies in open, laparoscopic or robotic surgeries.