BackgroundThere has been increasing interest in en bloc resection of bladder tumour (ERBT) as an oncologically non-inferior alternative to transurethral resection of bladder tumour (TURBT) with fewer complications and better histology specimens. However, there is a lack of robust randomised controlled trial (RCT) data for making recommendations.
ObjectiveWe aimed to develop a consensus statement to standardise various aspects of ERBT for clinical practice and to guide future research.
Design, Setting and ParticipantsWe developed the consensus statement on ERBT using a modified Delphi method.First, two systematic reviews were performed to investigate the clinical effectiveness of ERBT versus TURBT (effectiveness review), and to identify areas of uncertainty in ERBT (uncertainties review). Next, 200 health care professionals (urologists, oncologists and pathologists) with experience in ERBT were invited to complete a two-round Delphi survey. Finally, a 16-member consensus panel meeting was held to review, discuss and re-vote on the statements as appropriate.
Outcome Measurements and Statistical AnalysisMeta-analyses were performed for RCT data in the effectiveness review. Consensus statements were developed from the uncertainties review. Consensus was defined as:(1) ≥70% scoring a statement 7-9 AND ≤15% scoring the statement 1-3 (consensus agree); OR (2) ≥70% scoring a statement 1-3 AND ≤15% scoring the statement 7-9 (consensus disagree).
Results and LimitationsA total of 10 RCTs were identified upon systematic review. ERBT had a shorter irrigation time (mean difference -7.24 hours, 95% CI -9.29 --5.20, I 2 =85%, p<0.001) and lower rate of bladder perforation (Risk ratio [RR] 0.30, 95% CI 0.11-0.83, I 2 =1%, p=0.02) than TURBT, both with moderate certainty of evidence. There were no significant differences in recurrences at 0-12 months, 13-24 months or 25-36 months (all very low certainty of evidence). A total of 103 statements were developed and 99
