Transurethral En Bloc Resection Versus Standard Resection of Bladder Tumour: A Randomised, Multicentre, Phase 3 Trial

Area of Science:

• Urology
• Surgical Oncology

Background:

• Standard resection (SR) for non-muscle-invasive bladder cancer (NMIBC) involves piecemeal tumor removal.
• En bloc resection of bladder tumor (ERBT) is an alternative surgical technique proposed for NMIBC.
• The study aimed to compare the efficacy of ERBT versus SR in reducing NMIBC recurrence.

Purpose of the Study:

• To evaluate if en bloc resection of bladder tumor (ERBT) improves the 1-year recurrence rate of non-muscle-invasive bladder cancer (NMIBC) compared to standard resection (SR).

Main Methods:

• A multicentre, randomised, phase 3 trial conducted in Hong Kong.
• Adult patients with bladder tumors ≤ 3cm were randomized to ERBT or SR (1:1 ratio).
• Primary outcome was the 1-year recurrence rate, with secondary outcomes including operative time, complications, and progression rates.

Main Results:

• ERBT showed a significantly lower 1-year recurrence rate (29%) compared to SR (38%) in NMIBC patients (p = 0.007).
• Subgroup analysis indicated benefits of ERBT for specific tumor characteristics (1-3 cm, single, Ta, intermediate-risk).
• No significant difference was observed in progression rates, operative time, or hospital stay between the groups.

Conclusions:

• En bloc resection of bladder tumor (ERBT) significantly reduces the 1-year recurrence rate for NMIBC patients with tumors ≤ 3cm.
• The findings support ERBT as a preferred first-line surgical treatment for eligible NMIBC.
• Further research may explore long-term outcomes and cost-effectiveness.