En Bloc Resection for Bladder Tumors: An Updated Systematic Review and Meta-Analysis of Its Differential Effect on Safety, Recurrence and Histopathology
Language English Country United States Media print-electronic
Document type Journal Article, Meta-Analysis, Systematic Review
- Keywords
- pathology, recurrence, urinary bladder neoplasms,
- MeSH
- Cystectomy adverse effects methods MeSH
- Operative Time MeSH
- Neoplasm Invasiveness MeSH
- Urinary Catheterization MeSH
- Humans MeSH
- Neoplasm Recurrence, Local MeSH
- Urinary Bladder injuries MeSH
- Urinary Bladder Neoplasms pathology surgery MeSH
- Postoperative Complications MeSH
- Disease Progression MeSH
- Margins of Excision MeSH
- Neoplasm, Residual MeSH
- Risk Factors MeSH
- Mucous Membrane pathology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
- Systematic Review MeSH
PURPOSE: En bloc resection for bladder tumors has been developed to overcome shortcomings of conventional transurethral resection of bladder tumors with regard to safety, pathological evaluation and oncologic outcomes. However, the potential benefits and utility compared to conventional transurethral resection of bladder tumors have not been conclusively demonstrated. We aimed to update the current evidence with focus on the pathological benefits of en bloc resection for nonmuscle-invasive bladder cancer. MATERIALS AND METHODS: The PubMed®, Web of Science™ and Scopus® databases were searched in August 2021 according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement. Studies were deemed eligible if they compared safety, and pathological and clinical outcomes in patients who underwent en bloc resection with conventional transurethral resection of bladder tumors. RESULTS: Overall, 29 studies comprising 4,484 patients were eligible for this meta-analysis. Among 13 randomized controlled trials, the pooled 12- and 24-month recurrence risk ratios were not statistically different between the 2 surgical techniques (0.96, 95% CI 0.74-1.23 and 0.83, 95% CI 0.55-1.23, respectively). The pooled risk ratio for bladder perforation was 0.13 (95% CI 0.05-0.34) in favor of en bloc resection. In randomized controlled trials, the differential rates of detrusor muscle presence (pooled RR 1.31, 95% CI 1.19-1.43) and of detectable muscularis mucosae (pooled RR 2.69, 95% CI 1.81-3.97) were more likely in patients receiving en bloc resection. Patients who underwent en bloc resection had a lower rate of residual tumor at repeat transurethral resection than those treated with conventional transurethral resection of bladder tumors in 1 randomized controlled trial and 3 observational studies (pooled RR 0.47, 95% CI 0.31-0.71). CONCLUSIONS: En bloc resection for bladder tumors seems to be safer, and to yield superior histopathological information and performance compared to conventional transurethral resection of bladder tumors. Despite the failure to improve the recurrence rate, the more accurate histopathological analysis is likely to improve clinical decision making and care delivery in nonmuscle-invasive bladder cancer.
Department of Pathology Medical University of Vienna Vienna Austria
Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic
Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria
Department of Urology Jikei University School of Medicine Tokyo Japan
Department of Urology King Fahad Specialist Hospital Dammam Saudi Arabia
Department of Urology King Faisal Medical City Abha Saudi Arabia
Department of Urology Medical University of Silesia Zabrze Poland
Department of Urology University Medical Centre Hamburg Eppendorf Hamburg Germany
Department of Urology University of Texas Southwestern Medical Center Dallas Texas
Department of Urology Weill Cornell Medical College New York New York
Hourani Center for Applied Scientific Research Al Ahliyya Amman University Amman Jordan
Institute for Urology and Reproductive Health Sechenov University Moscow Russia
Karl Landsteiner Institute of Urology and Andrology Vienna Austria
Research Center for Evidence Based Medicine Tabriz University of Medical Sciences Tabriz Iran
References provided by Crossref.org
Association of energy source with outcomes in en bloc TURB: secondary analysis of a randomized trial
En bloc resection of bladder tumour: the rebirth of past through reminiscence