En-Bloc Transurethral Resection of Non-Muscle-Invasive Bladder Cancer. Current Evidence and Glimpses into the Future| Biomed Grid

Background: The purpose of this review was to summarize the current evidence on en-bloc transurethral resection (eTURB) of non-muscle-invasive bladder cancer compared to conventional TURB (cTURB) with a particular emphasis on ongoing randomized trials. Materials and methods: A PubMed/MEDLINE search of the English-language literature from its inception until June 2019 using the following terms in isolation or combination “bladder cancer”, “en bloc”, “TURB” and “resection” was performed. Evidence synthesis: Compared to cTURB, eTURB has been shown to achieve higher rates of detrusor muscle (>95%) and better quality of the specimen for pathological evaluation. Complication rates and perioperative outcomes are comparable between the two techniques. Moreover, eTURB seems to achieve lower recurrence rates. However, the retrospective nature of the studies and underpowered prospective trials limit the interpretation of these results. There are currently two active randomized trials which are evaluating the one-year recurrence rate (EB-StaR) and difference in the rate of detrusor muscle in the specimen between cTURB and eTURB (eBLOC), respectively. Conclusion: eTURB seems to provide a significant improvement in the surgical management of NMIBC with regards to oncology and safety outcomes.