En bloc resection of bladder tumor (ERBT) has been introduced to enhance the quality of resection of bladder cancer. This review aims to compare the perioperative and oncological outcomes of ERBT and conventional transurethral resection of bladder tumor (cTURBT).
A literature search was conducted using the PubMed/Medline, Embase, and Web of Science databases to identify randomized controlled trials published until May 2024. The primary outcomes were the risk of recurrence and progression. The secondary outcomes were detrusor muscle (DM) presence, muscularis mucosae (MM) detectability, bladder perforation and obturator nerve reflex rates, operative time, length of catheterization and hospitalization, and residual tumor at repeat transurethral resection of bladder tumor (reTURBT).
Seventeen studies met our inclusion criteria. No statistically significant difference was observed in 12-mo recurrence (risk ratio [RR] 0.81, 95% confidence interval [CI]: 0.65-1.02; p = 0.08), 24-mo recurrence (RR 1.02, 95% CI: 0.85-1.22; p = 0.8), and 12-mo progression (RR 0.68, 95% CI: 0.05-10.14; p = 0.8) rates. ERBT was significantly associated with a higher DM presence (RR 1.10, 95% CI: 1.01-1.20; p = 0.02), while no statistically significant difference emerged in the residual tumor at reTURBT and MM detectability (all p > 0.05). ERBT was significantly associated with a lower risk of bladder perforation (p = 0.002) and obturator nerve reflex (p < 0.001). Finally, ERBT was significantly associated with longer operative time, lower catheterization time, and lower length of hospital stay. The main limitation was heterogeneity among the included studies.
ERBT is safer due to fewer intraoperative events, but there was no significant difference in oncological outcomes compared with cTURBT. Higher DM detection with ERBT enhances initial disease stratification, potentially improving clinical decision-making and care delivery.
En bloc resection of bladder tumors is associated with lower intraoperative complications than and superior histopathological information to the conventional resection technique. However, the absence of a difference in oncological outcomes underscores the influence of factors such as tumor characteristics, surgeon expertise, and postoperative care on subsequent events.
European urology oncology. 2024 Oct 19 [Epub ahead of print]
Giuseppe Basile, Alessandro Uleri, Riccardo Leni, Donato Cannoletta, Luca Afferi, Michael Baboudjian, Pietro Diana, David D'Andrea, Jeremy Teoh, Benjamin Pradere, José D Subiela, Ekaterina Laukhtina, Thomas Seisen, Morgan Rouprêt, Alberto Briganti, Francesco Montorsi, Marco Moschini, Alberto Breda, Andrea Gallioli, European Association of Urology—Young Academic Urologists (EAU-YAU): Urothelial Carcinoma Working Group
Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy. Electronic address: ., Department of Biomedical Sciences, Humanitas University, Milan, Italy., Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy., Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy; Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain., Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain; Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland; European Association of Urology-Young Academic Urologists (EAU-YAU): Urothelial Carcinoma Working Group., Department of Urology, North Hospital, Aix-Marseille University, AP-HM, Marseille, France., Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain., European Association of Urology-Young Academic Urologists (EAU-YAU): Urothelial Carcinoma Working Group; Comprehensive Cancer Center, Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria., European Association of Urology-Young Academic Urologists (EAU-YAU): Urothelial Carcinoma Working Group; Department of Surgery, Faculty of Medicine, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China., European Association of Urology-Young Academic Urologists (EAU-YAU): Urothelial Carcinoma Working Group; Department of Urology UROSUD, La Croix du Sud Hôpital, Quint Fonsegrives, France., Department of Urology, Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain., Urology, GRC 5 Predictive Onco-Uro, AP-HP, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France., Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain; European Association of Urology-Young Academic Urologists (EAU-YAU): Urothelial Carcinoma Working Group.