Comparison of Pathological Outcome and Recurrence Rate between En Bloc Transurethral Resection of Bladder Tumor and Conventional Transurethral Resection: A Meta-Analysis

SIMPLE SUMMARY: The conventional surgery for early-stage localized bladder tumor is transurethral resection of bladder tumor (TURBT), but this surgical method cannot preserve the integrity of tumor appearance. Therefore, it results in lower identification rate of detrusor muscle of bladder which plays an importance role in bladder cancer staging. The en bloc procedure, which has raised more concern recently, is performed by resecting the tumor completely rather than piece-by-piece. This method improved the pathological outcome and also improved the underestimation rate of bladder cancer stage. Considering its several advantages, we conducted a meta-analysis to analyze current published studies, and the results showed promising outcomes for bladder cancer staging. ABSTRACT: Current treatment for non-muscle invasive bladder cancer (NMIBC) is the conventional transurethral resection of bladder tumor (CTURBT), but the en bloc transurethral resection of bladder tumor (ERBT) has been gaining more attraction in recent years considering better specimen integrity. Thus, we conducted this meta-analysis to compare the safety and efficacy of ERBT versus CTURBT. Trials were collected from an online database. The primary outcomes included identification of detrusor muscle in specimen, residual tumor, 3, 12, and 24-month recurrence rates and same-site recurrence rate. A total of 31 trials were included. The ERBT group had a higher rate of identification of detrusor muscle in specimens (p = 0.003) and lower residual tumor (p < 0.001). Other than that, lower rates of 3-month (p = 0.005) and 24-month recurrence rate (p < 0.001), same-site recurrence rate (p < 0.001) and complications were also observed. For perioperative outcomes, shorter hospitalization time (HT) (p < 0.001), and catheterization time (CT) (p < 0.001) were also revealed in the ERBT group. No significant difference was found in operative time (OT) (p = 0.93). The use of ERBT showed better pathological outcomes and fewer complications, so it could be considered a more effective treatment option for NMIBC.