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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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.</p><p><strong>Results: </strong>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, I<sup>2</sup>=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, I<sup>2</sup>=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, I<sup>2</sup>=52%) and obturator nerve reflex (OR 0.27, 95% CI 0.10-0.74, p=0.01, I<sup>2</sup>=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, I<sup>2</sup>=78%).</p><p><strong>Conclusions: </strong>ERBT might have oncologic and perioperative benefits, in addition to technical advantages, relative to cTURBT. 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Overall data favored ERBT in RFS (hazard ratio [HR] 0.85, 95% confidence interval [CI] 0.71-1.01, p=0.07, I<sup>2</sup>=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, I<sup>2</sup>=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, I<sup>2</sup>=52%) and obturator nerve reflex (OR 0.27, 95% CI 0.10-0.74, p=0.01, I<sup>2</sup>=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, I<sup>2</sup>=78%).</p><p><strong>Conclusions: </strong>ERBT might have oncologic and perioperative benefits, in addition to technical advantages, relative to cTURBT. 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引用次数: 0
摘要
简介：经尿道膀胱肿瘤整体切除术（ERBT）已成为传统经尿道膀胱肿瘤切除术（cTURBT）的替代技术。虽然在理论上是有利的，但ERBT在各种技术方法中的相对有效性仍不清楚。我们进行了一项最新的系统回顾和荟萃分析，以评估ERBT与ctturt的围手术期、病理和肿瘤预后。方法：我们系统地检索PubMed、EMBASE、Scopus和谷歌Scholar，检索比较ERBT和ctturt的随机对照试验（rct）。主要终点为无复发生存期（RFS）。次要结果是手术时间、并发症发生率、逼尿肌的存在以及是否需要重复切除。进行meta分析，采用ERBT技术分层亚组分析。结果：共纳入10项随机对照试验，共纳入1973例患者（1012例ERBT， 961例cTURBT）。总体数据支持ERBT治疗RFS（风险比[HR] 0.85, 95%可信区间[CI] 0.71-1.01, p=0.07, I2=48%），双相ERBT显著改善RFS（风险比[HR] 0.51, 95% CI 0.32-0.81, p=0.004）。与ctturbt相比，ERBT的手术时间更长（MD为3.52分钟，95% CI 1.25 ~ 5.80, p=0.001, I2=71%）。两组患者导尿时间和住院时间无显著差异。与cTURBT相比，ERBT的膀胱穿孔发生率（比值比[OR] 0.41, 95% CI 0.16-1.04, p=0.06, I2=52%）和闭孔神经反射发生率（比值比[OR] 0.27, 95% CI 0.10-0.74, p=0.01, I2=79%）均无显著性降低。ERBT与高逼尿肌存在无显著相关性（OR 2.08, 95% CI 0.94-4.58, p=0.07, I2=78%）。结论：与ctturt相比，ERBT除了技术优势外，还可能具有肿瘤学和围手术期的益处。使用的切除工具的不同会影响结果的一致性。
Comparative effectiveness of en-bloc resection techniques vs. conventional transurethral resection for non-muscle-invasive bladder cancer: A systematic review and meta-analysis.
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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