Efficiency of transurethral en-bloc resection vs. conventional transurethral resection for non-muscle-invasive bladder cancer: An umbrella review

Abstract

Background: En-Bloc transurethral resection of bladder tumor (ERBT) was clinically used to resect non-muscle-invasive bladder cancer (NMIBC). However, discrepancies persist regarding the comparisons between ERBT and conventional transurethral resection of bladder tumor (cTURBT).

Methods: We conducted a comprehensive search in PubMed, Embase, Web of Science, Cochrane Database of Systematic Reviews, and performed manual searches of reference lists to collect and extract data. Data evaluation was carried out using Review Manager 5.4.0, Rx64 4.1.3, and relevant packages.

Results: There were nine eligible meta-analyses and nine eligible RCTs in our study. NMIBC patients undergoing ERBT were significant associated with a lower rate of bladder perforation and obturator nerve reflex compared to those receiving cTURBT. Our pooled result indicated that ERBT and cTURBT required similar operation time. Regarding postoperative outcomes, ERBT demonstrated superior performance compared to cTURBT in terms of detrusor muscle presence, catheterization time, and residual tumor. ERBT exhibited a higher rate of three-month recurrence-free survival (RFS) compared to those receiving cTURBT (p < 0.05; I² = 0%). In bipolar subgroup, ERBT had a significant better 12-month RFS than cTURBT (p < 0.05; I² = 0%). Simultaneously, the exclusion of Hybrid Knife data revealed a significant improvement in 12-month RFS associated with ERBT (p < 0.05; I² = 50%).

Conclusion: Using a combination of umbrella review and meta-analysis, we demonstrated that ERBT had better or comparable perioperative outcome and improved 3 and 12 month RFS than cTURBT. We suggest that ERBT maybe a better surgical method for patients with NMIBC compared with cTURBT.

Keywords: En bloc resection of bladder tumor; bladder cancer; transurethral resection of bladder tumor; urothelial carcinoma.

FIGURE 1

Work flow diagram.

FIGURE 2

Quality assessment of included RCTs (A), outcomes during operation from meta‐analyses (B), pooled result (C), and sensitivity analysis, (D) of operation time.

FIGURE 3

Postoperative outcomes from meta‐analyses, (A) pooled result of bladder irritation (B).

FIGURE 4

Recurrence‐free survival (RFS) outcomes from meta‐analyses (A), pooled result of 3‐month RFS (B), pooled result (C), and sensitivity analysis (D), of 12‐month RFS, pooled result of more than 12‐month RFS (E).