Comparative effectiveness of en-bloc resection techniques vs. conventional transurethral resection for non-muscle-invasive bladder cancer: A systematic review and meta-analysis.
David E Hinojosa-Gonzalez, Gal Saffati, Troy La, Jackson Cathey, Juan C Angulo-Lozano, Gustavo Salgado-Garza, Jonathan Walsh, Bailey Slawin, Shane Kronstedt, Kate Lowrey, Jeremy R Slawin
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引用次数: 0
Abstract
Introduction: Transurethral en-bloc resection of bladder tumor (ERBT) has emerged as an alternate technique to conventional transurethral resection of bladder tumor (cTURBT). While theoretically advantageous, the comparative effectiveness of ERBT across various technical approaches remains unclear. We performed an updated systematic review and meta-analysis to evaluate perioperative, pathologic, and oncologic outcomes of ERBT vs. cTURBT.
Methods: We systematically searched PubMed, EMBASE, Scopus, and Google Scholar for randomized controlled trials (RCTs) comparing ERBT and cTURBT. The primary outcome was recurrence-free survival (RFS). Secondary outcomes were operative time, complication rates, detrusor muscle presence, and need for repeated resection. Meta-analyses were performed, with subgroup analyses stratified by ERBT technique.
Results: A total of 10 RCTs with 1973 patients (1012 ERBT, 961 cTURBT) were included. Overall data favored ERBT in RFS (hazard ratio [HR] 0.85, 95% confidence interval [CI] 0.71-1.01, p=0.07, I2=48%), with bipolar ERBT demonstrating significantly improved RFS (HR 0.51, 95% CI 0.32-0.81, p=0.004). ERBT had longer operative times compared to cTURBT (MD 3.52 minutes, 95% CI 1.25-5.80, p=0.001, I2=71%). There were no significant differences in catheter time or hospital stay between groups. ERBT had a non-significant lower incidence of bladder perforation (odds ratio [OR] 0.41, 95% CI 0.16-1.04, p=0.06, I2=52%) and obturator nerve reflex (OR 0.27, 95% CI 0.10-0.74, p=0.01, I2=79%) compared to cTURBT. ERBT was not significantly associated with higher detrusor muscle presence (OR 2.08, 95% CI 0.94-4.58, p=0.07, I2=78%).
Conclusions: ERBT might have oncologic and perioperative benefits, in addition to technical advantages, relative to cTURBT. Variations in resection instruments used impact the consistency of results.
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CUAJ is a a peer-reviewed, open-access journal devoted to promoting the highest standard of urological patient care through the publication of timely, relevant, evidence-based research and advocacy information.
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