En Bloc Transurethral Resection of Bladder Tumors vs Conventional Transurethral Resection of Bladder Tumors for Nonmuscle Invasive Bladder Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

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Purpose: En bloc transurethral resection of bladder tumor (eTURBT) has been proposed as an oncologically comparable alternative to conventional transurethral resection of bladder tumors (cTURBT), with fewer complications and better histological specimen quality. Recently, randomized controlled trials (RCT) comparing en bloc resection and conventional transurethral resection have been published. This study assessed the safety, efficacy, and perioperative and oncological outcomes of eTURBT and cTURBT. Materials and Methods: A systematic review and meta-analysis were conducted using Cochrane CENTRAL, PubMed, Embase, and Web of Science databases. End points from eligible studies that compared en bloc resection and conventional transurethral resection were analyzed using a random effects model. Outcomes included safety (bladder perforation [BP], absence of detrusor muscle [DM], and obturator nerve reflex [ONR]), perioperative outcomes (operative time, length of hospital stay, and catheterization time), and oncological results (recurrence rates, recurrence-free survival, and residual tumor rate). Results: Thirteen RCTs including 2366 patients (1213 en bloc, 1153 conventional) were included. No significant differences were observed in BP, absence of DM, or perioperative outcomes. However, en bloc resection, especially when performed with a laser, had a significantly lower ONR risk (odds ratio [OR] 0.14, 95% confidence interval [CI] 0.04-0.50; P < .01). The recurrence rates were comparable; however, en bloc resection showed a lower residual tumor rate (OR 0.43, 95% CI 0.18-1.02; P = .05). Differences in the study design and population must be considered. Conclusions: This review indicated comparable outcomes between eTURBT and cTURBT. A lower risk of ONR was observed with en bloc resection, particularly when performed using a laser. In addition, en bloc resection significantly reduced the residual tumor rate at Re-TURBT.

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