<i>En Bloc</i>
            Resection for Bladder Tumors: An Updated Systematic Review and Meta-Analysis of Its Differential Effect on Safety, Recurrence and Histopathology

Yanagisawa, Takafumi; Mori, Keiichiro; Motlagh, Reza Sari; Kawada, Tatsushi; Mostafaei, Hadi; Quhal, Fahad; Laukhtina, Ekaterina; Rajwa, Paweł; Aydh, Abdulmajeed; König, Frederik; Pallauf, Maximilian; Pradere, Benjamin; D’Andrea, David; Compérat, Eva; Miki, Jun; Kimura, Takahiro; Egawa, Shin; Shariat, Shahrokh F.

doi:10.1097/ju.0000000000002444

Cited by 37 publications

(43 citation statements)

References 46 publications

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“…A recent meta-analysis involving 29 studies also showed that ERBT had a significantly higher DM presence rate in primary ERBT specimens and a significantly lower tumor residual rate in reresection specimens than traditional TURBT. It is consistent with our study ( 23 ). In addition, our study also found that reresection did not seem to improve the prognosis of high-risk NMIBC patients with initial ERBT.…”

Section: Discussionsupporting

confidence: 94%

Can a reresection be avoided after initial en bloc resection for high-risk nonmuscle invasive bladder cancer? A systematic review and meta-analysis

Yin

et al. 2022

Front. Surg.

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BackgroundThis study aims to evaluate the effectiveness of en bloc resection for patients with nonmuscle invasive bladder cancer (NMIBC) and explore whether a reresection can be avoided after initial en bloc resection.Material and methodsWe conducted research in PubMed, EMBASE, Cochrane Library, and Web of Science up to October 12, 2021, to identify studies on the second resection after initial en bloc resection of bladder tumor (ERBT). R software and the double arcsine method were used for data conversion and combined calculation of the incidence rate.ResultsA total of 8 studies involving 414 participants were included. The rate of detrusor muscle in the ERBT specimens was 100% (95%CI: 100%–100%), the rate of tumor residual in reresection specimens was 3.2% (95%CI: 1.4%–5.5%), and the rate of tumor upstaging was 0.3% (95%CI: 0%–1.5%). Two articles compared the prognostic data of the reresection and non-reresection groups after the initial ERBT. We found no significant difference in the 1-year recurrence-free survival (RFS) rate (OR = 1.44, 95%CI: 0.67–3.09, P = 0.35) between the two groups nor in the rate of tumor recurrence (OR = 0.72, 95%CI: 0.44–1.18, P = 0.2) or progression (OR = 0.98, 95%CI: 0.33–2.89, P = 0.97) at the final follow-up.ConclusionsERBT can almost completely remove the detrusor muscle of the tumor bed with a very low postoperative tumor residue and upstaging rate. For high-risk NMIBC patients, an attempt to appropriately reduce the use of reresection after ERBT seems to be possible.

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Section: Discussionsupporting

confidence: 94%

Can a reresection be avoided after initial en bloc resection for high-risk nonmuscle invasive bladder cancer? A systematic review and meta-analysis

Yin

et al. 2022

Front. Surg.

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“…In contrast to ‘piecemeal’ resection by cTURB, ERBT incorporates a more delicate en bloc sculpting and tumor excision [ 43 ]. ERBT appears safe, feasible, and effective with demonstrably higher rates of DM in the pathologic specimen and provides better staging [ 6 ]. Given the excellent quality of the initial resection provided by ERBT and evidence supporting the completeness of tumor resection and reduced residual disease, ERBT might result in less need for reTURB.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, there has been increasing evidence to support the clinical benefit of ERBT. Compared to cTURB, ERBT has a higher DM presence rate, seems safer, and yields superior histopathologic information and performance [ 6 , 7 ]. ERBT is most feasible for patients with bladder tumor size of ≤3 cm.…”

Section: Introductionmentioning

confidence: 99%

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

Zhou

Yang

et al. 2022

JCM

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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.

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“…The pooled data of a meta-analysis comparing two RCTs and four observational studies showed a higher rate of detectable muscolaris mucosae in ERBT compared with TURBT (risk ratio: 2.69, 95% CI 1.81–3.97, z = 4.94 and risk ratio: 2.02, 95% CI 1.09–3.75, z = 2.22 for RCTs and observational studies, respectively) [4 ▪ ]. The clinical significance of T1 substaging is still not accepted broadly [23].…”

Section: Quality Of the Pathological Specimenmentioning

confidence: 97%

“…However, the current bulk of evidence provides a low level of evidence and controversial results regarding the superiority of one technique over the other [4 ▪ ,5 ▪▪ ,10].…”

Section: Introductionmentioning

confidence: 99%

En-bloc resection of non-muscle invasive bladder cancer: does it really make a difference?

Tonin

Shariat

Schiavina

et al. 2023

Current Opinion in Urology

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Purpose of review Transurethral resection of bladder tumour (TURBT) followed by pathology investigation of the obtained specimens is the initial step in the management of urinary bladder cancer (UBC). By following the basic principles of oncological surgery, en-bloc resection of bladder tumour (ERBT) aims to overcome the limitations associated with conventional transurethral resection, and to improve the quality of pathological specimens for a better decision making. The current bulk of evidence provides controversial results regarding the superiority of one technique over the other. The aim of this article is to summarize the recent data and provide evidence on this unanswered question. Recent findings Despite heterogeneous and controversial data, ERBT seems to have a better safety profile and deliver higher quality pathologic specimens. However, the recent evidence failed to support the hypothesized oncological potential benefits of ERBT in the initial surgical treatment of patients with UBC. Summary ERBT has gained increasing interest globally in the past decade. It continues to represent a promising strategy with a variety of features intended to solve the inherent limitations of TURBT. However, the current quality of evidence does not allow solid conclusions to be drawn about its presumed superiority compared with the conventional technique.

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En Bloc Resection for Bladder Tumors: An Updated Systematic Review and Meta-Analysis of Its Differential Effect on Safety, Recurrence and Histopathology

Cited by 37 publications

References 46 publications

Can a reresection be avoided after initial en bloc resection for high-risk nonmuscle invasive bladder cancer? A systematic review and meta-analysis

Can a reresection be avoided after initial en bloc resection for high-risk nonmuscle invasive bladder cancer? A systematic review and meta-analysis

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

En-bloc resection of non-muscle invasive bladder cancer: does it really make a difference?

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