En bloc transurethral resection versus conventional transurethral resection for non-muscle invasive bladder cancer: a systematic review and meta-analysis.

BACKGROUND

The gold standard treatment for non-muscle invasive bladder cancer (NMIBC) is transurethral resection of the bladder tumor (TURBT). En bloc transurethral resection is a new method for non-muscle invasive bladder cancer that may improve some shortcomings of TURBT. The aim of this systematic review and meta-analysis was to compare the perioperative and prognostic outcomes of en bloc transurethral resection and TURBT for NMIBC.

METHODS

Literature searches were conducted using PubMed, Embase, Cochrane Library, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), WanFang Data (WanFang) and VIP Information Network (VIP). We only included randomized controlled trials (RCTs). We used the Cochrane risk of bias 2.0 tool and modified Jadad scale to assess the quality of the literature. Statistical analyses were conducted using Review Manager 5.3 software (RevMan) and Stata SE software.

RESULTS

We included 16 RCTs comprising 1,505 patients (experimental group: 827; control group: 678). There were no significant differences between en bloc transurethral resection and TURBT in operation time [standard mean difference (SMD) =-0.21, 95% confidence interval (CI): -0.70 to -0.28, P=0.40] and 3-month recurrence rate [relative risk (RR) =0.14, 95% CI: 0.02-1.08, P=0.06]. Compared with TURBT, en bloc transurethral resection significantly decreased 6-month recurrence rate (RR =0.43, 95% CI: 0.26-0.69, P<0.001), 1-year recurrence rate (RR =0.36, 95% CI: 0.25-0.53, P<0.001), positive number of the biopsy at the tumor base (RR =0.17, 95% CI: 0.07-0.43, P<0.001), vesical perforation (RR =0.22, 95% CI: 0.11-0.43, P<0.001), obturator nerve reflex (RR =0.39, 95% CI: 0.18-0.83, P=0.01), postoperative complications (RR =0.10, 95% CI: 0.02-0.41, P=0.002), hemorrhage (SMD =-2.13, 95% CI: -2.89 to -1.37, P<0.001), hospital stay [mean difference (MD) =-2.14, 95% CI: -2.81 to -1.47, P<0.001], bladder irrigation time (SMD =-2.80, 95% CI: -3.36 to -2.24, P<0.001), and catheterization period (SMD =-1.77, 95% CI: -2.63 to -0.91, P<0.001).

CONCLUSIONS

Compared with TURBT, en bloc transurethral resection appears to be a better treatment option for NMIBC.