En bloc resection of bladder tumors: challenges and unmet needs in 2022
Evangelos N Symeonidis1, Ka-Lun Lo2, Ka-Lun Chui2
1First Department of Urology, Aristotle University of Thessaloniki, School of Medicine, "G Gennimatas" General Hospital, Thessaloniki, 54635, Greece.
Abstract:
Non-muscle invasive bladder cancer accounts for the majority of new bladder cancer diagnoses, and endoscopic transurethral resection of bladder tumor (TURBT) represents the standard-of-care. Although a relatively safe and common procedure, TURBT is often hampered by the questionable quality of resection. The evolution of surgical techniques has brought en bloc resection of bladder tumor (ERBT) to the forefront. ERBT has emerged as an alternative to conventional TURBT, incorporating a more delicate en bloc sculpting and tumor excision, in contrast to 'piecemeal' resection by conventional TURBT. ERBT appears safe, feasible and effective with demonstrably higher rates of detrusor muscle in the pathologic specimen, all while providing better staging and obviating the need for a re-TURBT in selected patients. However, the method's adoption in the field is still limited. This review summarizes the recent evidence relevant to ERBT while further highlighting the technique's limitations and unmet needs.
Insights
En bloc resection of bladder tumor (ERBT) offers a superior alternative to traditional transurethral resection of bladder tumor (TURBT) for non-muscle invasive bladder cancer. ERBT provides better staging and reduces the need for repeat procedures.
Area of Science:
- Urology
- Surgical Oncology
- Oncology
Background:
- Non-muscle invasive bladder cancer (NMIBC) is the most common type of bladder cancer.
- Transurethral resection of bladder tumor (TURBT) is the standard treatment but often yields suboptimal resection quality.
- En bloc resection of bladder tumor (ERBT) is an evolving technique offering a potential improvement over conventional TURBT.
Purpose of the Study:
- To review recent evidence on en bloc resection of bladder tumor (ERBT).
- To highlight the advantages and limitations of ERBT compared to TURBT.
- To identify unmet needs and future directions for ERBT adoption.
Main Methods:
- Literature review of recent studies comparing ERBT and TURBT.
- Analysis of pathological specimen quality, including detrusor muscle presence.
- Evaluation of oncological outcomes, staging accuracy, and need for re-treatment.
Main Results:
- ERBT demonstrates higher rates of detrusor muscle in pathology specimens.
- ERBT facilitates more accurate staging of NMIBC.
- ERBT may obviate the need for re-TURBT in select patients, improving efficiency and reducing patient burden.
Conclusions:
- ERBT is a safe, feasible, and effective alternative to TURBT for NMIBC.
- Improved specimen quality with ERBT leads to better staging and potentially fewer repeat surgeries.
- Wider adoption of ERBT is limited, necessitating further research and standardization.
