En Bloc Versus Conventional Resection of Primary Bladder Tumor (eBLOC): A Prospective, Multicenter, Open-label, Phase 3 Randomized Controlled Trial

D’Andrea, David; Soria, Francesco; Hurle, Rodolfo; Enikeev, Dmitry; Котов, С. В.; Régnier, Sophie; Xylinas, Évanguelos; Lusuardi, Lukas; Heidenreich, Axel; Cai, Chao; Frego, Nicola; Taraktin, M.; Ryabov, Maxim; Compérat, Éva; Shariat, Shahrokh F.

doi:10.1016/j.euo.2023.07.010

Cited by 18 publications

(5 citation statements)

References 21 publications

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“…Its presence allows for proper staging, accurate risk strati cation, reduces the rate of second look procedures, and ensures better outcomes [3], [11], [12]. ERBT has shown to be superior to conventional piecemeal resection in prospective and randomized trials by achieving DM rates of > 80% [5], [6], [14]. However, there is only scarce evidence on the association of different energy sources used for ERBT with the quality of the resection and perioperative outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…This might lead to di culties in orientation and nal diagnosis during pathological examination. To improve the limitations of cTURB, the en-bloc resection of bladder tumor (ERBT) has emerged as increasingly applied technique [5][6] [7]. This approach does not only follow the oncological principle of removing malignant tissue 'en bloc' while ensuring negative resection margin around the resected area but also allows for precise orientation and integrity of the specimen, improving the precision of histopathological analysis and staging compared to cTURB [8].…”

Section: Introductionmentioning

confidence: 99%

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Association of energy source with outcomes in en bloc TURB. Secondary analysis of a randomized trial

Mancon,

Soria,

Hurle

et al. 2024

Preprint

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Purpose To comprehensively evaluate the efficacy of different energy sources used for en-bloc transurethral resection of bladder tumors (ERBT) on perioperative outcomes. Methods This sub-analysis derived from a prospective randomized study that enrolled patients undergoing ERBT vs conventional transurethral resection of the bladder (cTURB) from January 2019 to January 2022 (NCT03718754). Endpoints were to investigate the association of monopolar (m-ERBT), bipolar (b-ERBT), or laser (l-ERBT) ERBT with pathological specimen quality and perioperative outcomes. Results 237 bladder tumors resected in 188 patients included in the analyses: 29 (12.2%) m-ERBT, 136 (57.4%) b-ERBT and 72 (30.4%) l-ERBT. Detrusor muscle (DM) was detected in 191 (80.6%) specimens. Per-tumor analysis revealed comparable rate of DM in the specimens obtained via different energy modalities (p=0.7). Operative time was longer in the l-ERBT cohort compared to m-ERBT and b-ERBT (p=0.02) and no obturator nerve reflex (ONR) onset was reported. On logistic regression analysis, b-ERBT was associated with negative lateral resection margins (OR 2.81;95%CI 1.02-7.70; p=0.04). There was no significant association of the resection technique with perforation and conversion rates (all p > 0.05). Within a median follow up of 22mo (IQR 11-29), a total of 35 (18.6%) patients had a local recurrence. On Cox regression analysis, patients resected with b-ERBT were less likely to have a recurrence (HR 0.34; 95%CI 0.15-0.78; p=0.01); When adjusting for established confounders, this association was confirmed (HR 0.24; 95%CI 0.10-0.60; p=0.002). Conclusions Different energy sources might achieve comparable perioperative outcomes. Further perspectives involve the assessment of long-term differential oncological outcomes associated with various energy modalities.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of energy source with outcomes in en bloc TURB. Secondary analysis of a randomized trial

Mancon,

Soria,

Hurle

et al. 2024

Preprint

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“…First, Gellioli et al reported that ERBT was not inferior to TURBT in terms of the rate of muscularis propria present (94% vs. 95%, n = 248), but T1 substaging was feasible in 80% of the TURBT cases compared with 100% of the ERBT cases (p = 0.02) [73]. In the second trial, D'Andrea et al reported that ERBT was superior to TURBT in the retrieval of muscularis propria (80.7% vs. 71.1%; p = 0.01; n = 452) [74]. Finally, Teoh et al reported ERBT reduced the 1-year recurrence rates and progression rate compared to TURBT (28.5% vs. 38.1%; p = 0.007 and 0% vs. 2.6%; 0.065, respectively; n = 276) [75].…”

Section: Management Of Nmibc Turbt and En Bloc Resectionmentioning

confidence: 98%

Photodynamic Diagnosis and Therapy in Non-Muscle-Invasive Bladder Cancer

Kurabayashi,

Fukuhara,

Furihata

et al. 2024

Cancers

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Bladder cancer (BC) possesses distinct molecular profiles that influence progression depending on its biological nature and delivered treatment intensity. Muscle-invasive BC (MIBC) and non-MIBC (NMIBC) demonstrate great intrinsic heterogeneity regarding different prognoses, survival, progression, and treatment outcomes. Transurethral resection of bladder tumor (TURBT) is the standard of care in treating NMIBC and serves both diagnostic and therapeutic purposes despite the prevalent recurrence and progression among many patients. In particular, flat urothelial carcinoma in situ and urothelial carcinoma with lamina propria invasion are the major precursors of MIBC. A new-generation photosensitizer, 5-Aminolevulinic acid (5-ALA), demonstrates high tumor specificity by illuminating the tumor lesion with a specific wavelength of light to produce fluorescence and has been studied for photodynamic diagnosis to detect precise tumor areas by TURBT. Additionally, it has been applied for treatment by producing its cytotoxic reactive oxygen species, as well as screening for urological carcinomas by excreting porphyrin in the blood and urine. Moreover, 5-ALA may contribute to screening before and after TURBT in NMIBC. Here, we summarize the updated evidence and ongoing research on photodynamic technology for NMIBC, providing insight into the potential for improving patient outcomes.

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“…Sie konnten zeigen, dass ein Ta und T1 Substaging bei ERBT Präparaten schneller und mit signifikant geringerer Interobserver Variabilität erfolgen konnte. [22] Zuletzt wurden die Ergebnisse der europäischen, multizentrischen EBLOC Studie aus der Arbeitsgruppe um Shariat et al veröffentlicht, in der 384 Patienten 1:1 randomisiert wurden [23]. Monopolare und bipolare Elektroden sowie Laser waren als Energiequelle erlaubt.…”

Section: üBersicht Der Aktuellen Datenlage Zur Erbtunclassified

“…Die ERBT bietet zudem ein präziseres lokales Tumorstaging. Obwohl nicht aller der jüngsten RCTs dies nicht eindeutig bestätigten [17,20,21], zeigen die meisten Studien eine höhere Detektionsrate von Detrusormuskulatur [11,16,23]. Besonders hervorzuheben ist die häufigere Möglichkeit eines Substagings von T1-Tumoren: Ein T1 Substaging hat eine hohe prognostische Relevanz und kann zu einer differenzierteren Therapie beitragen [17,27,28].…”

Section: Diskussionunclassified

Sollten wir alle zur En Bloc Resektion von Blasentumoren wechseln?

Herrmann,

Hartung,

Kriegmair

et al. 2024

Aktuelle Urol

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ZusammenfassungBei der En-Bloc-Resektion von Blasentumoren (ERBT) erfolgt die Abtragung von Tumoren nicht fragmentiert, sondern sie werden in einer Schicht präpariert und, wenn möglich, in toto extrahiert. Diese Methode repräsentiert einen Paradigmenwechsel in der Behandlung nicht muskelinvasiver Blasentumore und bietet gegenüber der konventionellen transurethralen Resektion der Blase (TUR-B) diverse Vorteile. Insbesondere erlauben die so gewonnen histologischen Präparate eine genauere Aufarbeitung, was eine präzisere Stadieneinteilung ermöglicht. Zudem wird häufiger Detrusormuskulatur im Präparat nachgewiesen, was auf eine komplettere Tumorentfernung hindeutet. In den letzten Jahren festigt sich eine stabile Datenbasis, die die Vorteile dieser Technik bekräftigt. So wurde kürzlich in einer multizentrischen, prospektiv-randomisierten Studie erstmals ein signifikanter Vorteil hinsichtlich der Rezidivrate nach 12 Monaten im Vergleich zur TUR-B nachgewiesen. Versierte Endourologen sollten sich mit dieser Technik befassen, da sie sich mittelfristig zum Standard entwickeln könnte. Die Technik ist zu gut und zu elegant, um ignoriert zu werden.

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En Bloc Versus Conventional Resection of Primary Bladder Tumor (eBLOC): A Prospective, Multicenter, Open-label, Phase 3 Randomized Controlled Trial

Cited by 18 publications

References 21 publications

Association of energy source with outcomes in en bloc TURB. Secondary analysis of a randomized trial

Association of energy source with outcomes in en bloc TURB. Secondary analysis of a randomized trial

Photodynamic Diagnosis and Therapy in Non-Muscle-Invasive Bladder Cancer

Sollten wir alle zur En Bloc Resektion von Blasentumoren wechseln?

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