Safety and efficacy of en bloc transurethral resection versus conventional transurethral resection for primary nonmuscle-invasive bladder cancer: a meta-analysis

Dong Zhang,Lifeng Yao,Qi Ma,Junhui Jiang,Zejun Yan,Yue Cheng,Sui Yu

doi:10.1186/s12957-019-1776-4

Abstract

BackgroundThe purpose of this meta-analysis is to compare the safety and efficacy of en bloc transurethral resection of bladder tumor (EBRT) versus conventional transurethral resection of bladder tumor (CTURBT).MethodsWe performed a meta-analysis of relevant articles through November 2019 using PubMed, Embase, and Cochrane Central Register to compare the safety and efficacy of EBRT versus CTURBT. The main endpoint included the operation time (OT), hospitalization time (HT), catheterization time (AT), perioperative period complications, bladder detrusor muscle found in the specimen, the residual tumor on the base, the ratio of the same site recurrence, and 12/24/36-month recurrence rate. Cochrane Collaboration’s Revman software, version 5.3, was used for statistical analysis.ResultsA total of 19 studies with 2651 patients were included, 1369 underwent EBRT and 1282 underwent CTURBT. Patients treated with EBRT had a significantly lower AT, HT, obturator nerve reflex, bladder perforation, bladder irritation, postoperative complications, and 24-month recurrence rate than those who underwent CTURBT. While no significant difference was found in terms of OT, the ratio of bladder detrusor muscle found in the specimen, the residual tumor on the base, 12-month recurrence rate, 36-month recurrence rate, and the ratio of the same site recurrence. In mitomycin subgroup, EBRT was superior to CTURBT in terms of 12/24-month recurrence rate. Similarly, in the prospective subgroup and retrospective subgroup, EBRT had a lower 24-month recurrence rate than CTURBT. However, no significant difference was found in the low, intermediate, and high-risk group in the light of 12–36-month recurrence rate.ConclusionsBased on the included 19 articles, EBRT had a significantly lower AT, HT, intraoperative and postoperative complications, and 24-month recurrence rate than those treated with CTURBT. Well-designed randomized controlled trials were needed to reevaluate these outcomes.Trial registrationThis meta-analysis was reported in agreement with the PRISMA statement and was registered on PROSPERO 2019 CRD42019121673.

Highlights

The purpose of this meta-analysis is to compare the safety and efficacy of en bloc transurethral resection of bladder tumor (EBRT) versus conventional transurethral resection of bladder tumor (CTURBT)
We performed intravesical chemotherapy or Bacille Calmette-Guerin (BCG) for postoperative patients, mitomycin was used in five studies [8, 9, 15,16,17], epirubicin was used in seven studies [6, 7, 10, 12, 14, 23, 24], pirarubicin was used in five studies [13, 18, 20,21,22], BCG was used in one study [11], and BCG combined epirubicin [19] was used in one study
While no significant difference was found in terms of operation time (OT), the ratio of bladder detrusor muscle found in the specimen, the residual tumor on the base, 12-month recurrence rate, 36-month recurrence rate, and the ratio of the same site recurrence

Summary

Introduction

The purpose of this meta-analysis is to compare the safety and efficacy of en bloc transurethral resection of bladder tumor (EBRT) versus conventional transurethral resection of bladder tumor (CTURBT). For nonmuscle-invasive bladder cancer (NMIBC), conventional transurethral resection of bladder tumor (CTURBT) combined with intravesical chemotherapy or Bacille Calmette-Guerin (BCG) is the standard treatment [3]. Staging is often inaccurate because of charring of the resected tissues and absence of detrusor by TURBT. Complications such as obturator nerve reflex and bladder perforation may happen during the resection of lateral wall tumors, which is associated with urinary extravasation and neoplasm seeding [4]. Engilbertsson et al had demonstrated that CTURBT induced the bladder tumor cell into the blood circulation [5] It is unknown whether CTURBT will increase the rate of metastatic disease. The capacity to remove the neoplasm may yield the merit of shorter intervention time, because it avoids piece-bypiece removal by CTURBT, prolonged by necessity to perform repeated hemostasis so as to improve visibility [6, 7]

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