Key messages
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Blue light-supported resection (surgical removal) of the bladder may have little to no effect on the chance of cancer returning in people at low risk (risk for cancer returning), but may reduce the chance for those at medium and high risk.
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Blue light-supported resection of the bladder probably has little to no effect on the chance of cancer getting worse in people at low risk (for cancer getting worse) or medium risk, but may reduce the chance for those at high risk.
Why is a special visualization method (blue light) used during resection of the bladder?
In people who might have bladder cancer, the possible tumor is cut from the inner bladder wall using a special instrument inserted through the tube that carries urine from the bladder to outside the body (the urethra) into the bladder. However, it is sometimes difficult to tell what is normal bladder tissue and what is cancer. In order to see the tumor better and remove it completely, a liquid (contrast agent) is put into the bladder through a thin tube (catheter). During surgery, a special light is used to make the cancer cells light up red.
What did we want to find out?
We wanted to find out if using blue light-enhanced resection of the bladder is better than using white light during bladder surgery for people with non-muscle (superficial) invasive bladder cancer. We looked at whether it affects:
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the time it takes for cancer to return (recurrence);
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the time it takes for cancer to get worse (progression);
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whether people lived for longer;
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serious complications during surgery;
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mild complications during surgery;
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and if it had any unwanted effects.
What did we do?
We searched for studies which randomly assigned people with bladder cancer to have either blue light-enhanced resection of the bladder or white light-based resection of the bladder. We compared and summarized the results of these studies and rated our confidence in the evidence, based on factors such as study methods and sizes.
What did we find?
We identified 17 studies comparing the use of blue light-enhanced resection of the bladder to white light-based resection of the bladder. These studies involved a total of 4890 participants in the review. Blue light-enhanced resection of the bladder may have little to no effect on the risk of recurrence in people at low risk, but may reduce the risk of recurrence in those at medium and high risk. Blue light supported resection of the bladder probably has little to no effect on the risk of progression in people at low risk, may have little or no effect on the risk of progression in people at medium risk, but may reduce the risk of progression in those at high risk. We also found that blue light may have little to no effect on the number of mild or serious surgical complications, the risk of death from bladder cancer over time, any unwanted effects and mild surgical complications.
What are the limitations of the evidence?
The most significant limitations of the evidence considered in this review stem from the quality of the included studies. In some studies, the treatments were not delivered exactly as planned, making it harder to compare the groups fairly. Other studies had missing information, and the amount or reasons for missing data differed between treatment groups, which could affect the results. In addition, some studies may have reported only selected outcomes while leaving out others, creating a risk that the findings do not provide a complete picture of the intervention's effects.
How up to date is this evidence?
This review updates our previous review. The evidence is up to date to March 2026.
อ่านบทคัดย่อฉบับเต็ม
Disease recurrence and progression remain major challenges in the treatment of non-muscle invasive bladder cancer (NMIBC). Blue light-enhanced transurethral resection of bladder cancer (TURBT) is an approach to improve staging and achieve a complete resection of NMIBC.
วัตถุประสงค์
To assess the effects of blue light-enhanced TURBT compared to white light-based TURBT in the treatment of non-muscle invasive bladder cancer.
วิธีการสืบค้น
We searched several medical literature databases, including the Cochrane Library, MEDLINE, and Embase, as well as two trial registers, with no restrictions on language of publication or publication status, until March 2026.
เกณฑ์การคัดเลือก
We included randomized controlled trials using blue light versus white light TURBT. Included participants had a high level of suspicion based on imaging or ‘visible diagnosis’ for primary urothelial carcinoma of the bladder or recurrent urothelial carcinoma of the bladder upon cytoscopy. We excluded studies in which blue light was used in a surveillance setting.
การรวบรวมและวิเคราะห์ข้อมูล
Two review authors independently performed data extraction and risk of bias assessment. Our primary outcomes were time to disease recurrence, time to disease progression, and serious surgical complications. Secondary outcomes were time to death from bladder cancer, any adverse events, and non-serious complications. We rated the certainty of evidence using the GRADE approach.
ผลการวิจัย
We included 16 randomized controlled trials involving a total of 4325 participants in the review. The studies compared blue light versus white light TURBT for treatment of NMIBC.
Primary outcomes
Blue light TURBT may reduce the risk of disease recurrence over time (hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.54 to 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 white light TURBT, respectively.
Blue light TURBT may also reduce the risk of disease progression over time (HR 0.65, 95% CI 0.50 to 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 white light TURBT, respectively.
Blue light TURBT may have little or no effect on serious surgical complications (risk ratio (RR) 0.54, 95% CI 0.14 to 2.14; low-certainty evidence). This corresponded to 10 fewer (19 fewer to 25 more) surgical complications per 1000 participants with blue light TURBT.
Secondary outcomes
Blue light TURBT may have little or no effect on the risk of death from bladder cancer over time (HR 0.55, 95% CI 0.19 to 1.61; low-certainty evidence). This corresponded to 22 deaths per 1000 participants with white light TURBT and 10 fewer (17 fewer to 13 more) deaths per 1000 participants with blue light TURBT.
We are very uncertain how blue light TURBT affects the outcome adverse events of any grade (RR 1.09, 95% CI 0.88 to 1.33; low-certainty evidence).
No analysis was possible for the outcome non-serious surgical complications, as it was not reported by any of the included studies.
ข้อสรุปของผู้วิจัย
Blue light-enhanced TURBT for the treatment of non-muscle invasive bladder cancer compared to white light-based TURBT may reduce the risk of disease recurrence and disease progression over time, depending on baseline risk. There may be little or no effect on serious surgical complications. Blue light TURBT may have little to no effect on the time to death from bladder cancer, adverse events or non-serious surgical complications, respectively. The certainty of evidence for our findings was mostly low, meaning that future studies are likely to change the reported estimates of effect. Frequent issues that led us to downgrade the certainty of the evidence were study limitations, inconsistency, and imprecision.
แหล่งทุน
The update of this review had no dedicated funding.
การลงทะเบียน
Protocol (2020): DOI: 10.1002/14651858.CD013776
Original review (2021): DOI: 10.1002/14651858.CD013776.pub2
