A Systematic Review on the Role of Repeat Transurethral Resection after Initial en Bloc Resection for Non-Muscle Invasive Bladder Cancer

Abstract

International guidelines recommend repeat transurethral resection of bladder tumors (reTURB) for selected patients with high-risk non-muscle invasive bladder cancer to remove possible residual tumors, restage tumors and improve the therapeutic outcome. However, most evidence supporting the benefits of reTURB is from conventional TURB. The role of reTURB in patients receiving initial En bloc resection of bladder tumor (ERBT) is still unknown. PubMed, Embase, Web of Science, The Cochrane Library, and China National Knowledge Infrastructure (CNKI) were systematically searched. Finally, this systematic review and meta-analysis included twelve articles, including 539 patients. The rates of residual tumor and tumor upstaging detected by reTURB after ERBT were 5.9% (95%CI, 2.0%–11.1%) and 0.0% (95%CI, 0.0%–0.5%), respectively. Recurrence-free survival, tumor recurrence and progression were comparable between patients with and without reTURB after initial ERBT. The pooled hazard ratios of 1-year, 2-year, 3-year and 5-year recurrence-free survival were 0.74 (95%CI, 0.36–1.51; p = 0.40), 0.76 (95%CI, 0.45–1.26; p = 0.28), 0.83 (95%CI, 0.53–1.32; p = 0.43) and 0.83 (95%CI, 0.56–1.23; p = 0.36), respectively. The pooled relative risks of recurrence and progression were 0.87 (95%CI, 0.64–1.20; p = 0.40) and 1.11 (95%CI, 0.54–2.32; p = 0.77), respectively. Current evidence demonstrates that reTURB after ERBT for bladder cancer can detect relatively low rates of residual tumor and tumor upstaging and appears not to improve either recurrence or progression.

Leiomiomas del tracto urinario: neoplasias infrecuentes con un relevante diagnóstico diferencial

“…(15) Se ha descrito casos de recurrencia tras RTU resueltos con re-RTU o enucleación que permitieron la exéresis tumoral completa. (16) El pronóstico en general es excelente sin recurrencia ni malignización después de la extirpación completa.…”

Recent advancements in the diagnosis and treatment of non‐muscle invasive bladder cancer: Evidence update of surgical concept, risk stratification, andBCG‐treated disease

“…This data would recommend repeat TUR should be performed as the standard of care for patients with positive horizontal or vertical margins on initial EBTUR, but repeat TUR can be omitted for patients without positive surgical margins. A systematic review and meta‐analysis of 12 articles with 539 patients revealed that the pooled relative risks of intravesical recurrence and progression with and without repeat TUR after initial EBTUR were 0.87 ( p = 0.40) and 1.11 ( p = 0.77), respectively 22 . Current evidence suggests that repeat TUR after EBTUR for NMIBC is associated with relatively low rates of residual tumor and tumor upstaging but appears not to improve either recurrence or progression.…”

Active Surveillance in Non-Muscle Invasive Bladder Cancer, the Potential Role of Biomarkers: A Systematic Review

“…If detected, a transurethral resection of the bladder (TURBT) is performed to remove the tumor and to determine its stage and grade. TURBT is the standard procedure for the diagnosis of bladder cancer and also a crucial therapeutic procedure for patients with NMIBC [4]. Although TURBT has been a technique of choice for decades with relatively low morbidity, it is far from perfect due to the 30% risk of understaging, and other complications.…”