An updated systematic review, meta-analysis and trial sequential analysis of the efficacy and safety of en bloc transurethral resection vs. conventional transurethral resection for non-muscle-invasive bladder tumor.

Objective: En bloc transurethral resection of bladder tumor (ERBT) for non-muscular invasive bladder tumor (NMIBC) has been used in clinical practice, but its efficacy and safety have not been conclusional. We aimed to evaluate the efficacy and safety of ERBT and conventional transurethral resection of bladder tumor (cTURBT) for NMIBC.

Methods: Randomized controlled trials (RCTs) comparing ERBT and cTURBT in the treatment of NMIBC were searched in Pubmed, Embase, Clinicaltrials.gov and Cochrane, 12 RCTs were included for systematic review and meta-analysis using RevMan 5.4.

Results: A total of 12 RCTs involving 2097 patients with NMIBC were included and analyzed. The results showed the rate of identification of detrusor muscle in specimens (Odds Ratio (OR) 1.90; P = 0.03) was higher in ERBT group, and bladder perforation (OR 0.30; P = 0.004), obturator nerve reflex (OR 0.18; P = 0.001), catheter indwelling time (MD -0.64; P = 0.002), length of hospital stay (MD-0.58; P = 0.002), tumor recurrence rate 3 months after surgery (OR 0.42; P = 0.03), tumor recurrence rate 6 months after surgery (OR 0.21; P = 0.007), the recurrence rate of the same site 1 year after surgery (OR 0.23; P<0.0001) and bleeding rate (OR 0.30; P = 0.0005) were significantly lower in ERBT group than that in cTURBT group. There was no significant difference in residual tumor (OR 0.62; P = 0.07), Re-TURBT (OR 0.71; P = 0.19), hemoglobin deficit (MD-0.81; P = 0.29), urethral stricture (OR 0.67; P = 0.42), resection time (MD 2.31; P = 0.16), operative time (MD 1.17; P = 0.49), 1 year (OR 0.61; P = 0.13), 2 years (OR 0.94; P = 0.76), 3-year tumor recurrence rate (OR 1.03; P = 0.86) and the risk of progression at 12 month (OR 0.68; P = 0.79) between the two groups.

Conclusions: Our results showed that ERBT can improve the rate of identification of detrusor muscle in specimens and reduce the 3-month, 6-month tumor recurrence rate and recurrence rate of the same site 1 year after surgery. In addition, ERBT has fewer complications, and shorter catheter indentation time and hospital stay. The laser ERBT can also decrease tumor residual rate and re-TURBT.