Comparison of the efficacy and feasibility of en bloc transurethral resection of bladder tumor versus conventional transurethral resection of bladder tumor

Abstract

Background:The aim of this meta-analysis was to compare the feasibility of en bloc transurethral resection of bladder tumor (ETURBT) versus conventional transurethral resection of bladder tumor (CTURBT).Methods:Relevant trials were identified in a literature search of MEDLINE, EMBASE, Cochrane Library, Web of Science, and Google Scholar using appropriate search terms. All comparative studies reporting participant demographics, tumor characteristics, study characteristics, and outcome data were included.Results:Seven trials with 886 participants were included, 438 underwent ETURBT and 448 underwent CTURBT. There was no significant difference in operation time between 2 groups (P = 0.38). The hospitalization time (HT) and catheterization time (CT) were shorter in ETURBT group (mean difference[MD] −1.22, 95% confidence interval [CI] −1.63 to −0.80, P < 0.01; MD −0.61, 95% CI −1.11 to −0.11, P < 0.01). There was significant difference in 24-month recurrence rate (24-month RR) (odds ratio [OR] 0.66, 95% CI 0.47–0.92, P = 0.02). The rate of complication with respect to bladder perforation (P = 0.004), bladder irritation (P < 0.01), and obturator nerve reflex (P < 0.01) was lower in ETURBT. The postoperative adjuvant intravesical chemotherapy was evaluated by subgroup analysis, and 24-month RR in CTURBT is higher than that in ETURBT in mitomycin intravesical irrigation group (P = 0.02).Conclusion:The first meta-analysis indicates that ETURBT might prove to be preferable alternative to CTURBT management of nonmuscle invasive bladder carcinoma. ETURBT is associated with shorter HT and CT, less complication rate, and lower recurrence-free rate. Moreover, it can provide high-qualified specimen for the pathologic diagnosis. Well designed randomized controlled trials are needed to make results comparable.

Retrograde en bloc resection for non-muscle invasive bladder tumor can reduce the risk of seeding cancer cells into the peripheral circulation

“…Although whether ERBT, compared with conventional TURB, could provide a better long-term survival for patients with NMIBC is controversial, a recent metaanalysis in which patients who received ERBT showed a significantly lower 24-month recurrence rate than that of patients who received conventional TURB [10]. In our study, 2 patients who experienced disease recurrence were in the TURB group.…”

“…Thus, whether RERBT remains a prophylactic effect for multifocal tumors or tumors of a larger size is unclear. However, to the best of our knowledge, we are the first to demonstrate that RERBT did not increase the number of cells in the bloodstream compared to conventional TURB, which may be a potential reason to explain the better oncological outcomes of patients who received ERBT than the outcomes of patients who were treated with conventional TURB [10,11]. We believe our preliminary study will encourage other groups conducting further prospective studies with larger sample sizes to gain insight into this field.…”

Technical developments in transurethral resection of bladder tumours

“…Finally, in a meta-analysis of 886 patients (438 en bloc, 448 cTURB) Wu et al proved that hospitalisation and catheterisation time were shorter in the en bloc group with no significant difference in operation time. Also, there was a significant difference in recurrence and complication rates in favour of en bloc resection [36].…”

Safety and efficacy of en bloc transurethral resection versus conventional transurethral resection for primary nonmuscle-invasive bladder cancer：a meta-analysis

“…Although the clinical recurrence rate between two approaches is controversial, less intraoperative and postoperative complications have been observed when undergoing EBRT. A meta-analysis published in 2016 revealed that EBRT had a lower 24-month recurrence rate than CTURBT [25]. However, recent 4 RCTs revealed that no significant difference was found in terms of 24-month, 18-month or 12-month recurrence rate [7,[12][13][14].…”