Chemotherapy-enhanced endoscopic submucosal En Bloc dissection vs. conventional TURBT for NMIBC: a comparative study

To evaluate the efficacy of integrating en bloc resection, endoscopic submucosal dissection (ESD), and submucosal injection of chemotherapeutic agents with TURBT (cESD-TURBT).

This retrospective observational study was conducted on patients diagnosed with stage cTa-T1 bladder cancer who received TURBT between December 2020 and July 2023 at Liaoning Cancer Hospital. The participants were grouped on the basis of the type of treatment they received: cESD-TURBT (n = 118) or conventional TURBT (cTURBT, n = 105). Hydroxycothecin is the chemotherapeutic agent used for submucosal injections. The primary outcome was the recurrence-free survival (RFS) of the treated patients with bladder cancer. The secondary outcomes included disease recurrence within one year, operation duration, length of postoperative hospitalization, and complication rates. Statistical analyses were performed via appropriate tests, with a threshold of P < 0.05 defined as statistically significant.

Compared with the cTURBT cohort, the cESD-TURBT cohort demonstrated increased RFS, with a median follow-up of 775 days (interquartile range [IQR] 414-1040). The recurrence rate in the cESD-TURBT cohort was 18.6% (22/118), whereas it was 39.1% (41/105) in the cTURBT cohort, with a log-rank hazard ratio of 0.49 (95% CI 0.29-0.82; p = 0.0053). Furthermore, cESD-TURBT resulted in fewer postoperative complications than did cTURBT, markedly reducing the occurrence of complications, such as the obturator reflex (1.7% vs. 8.6%, p = 0.03). The difference in operation time was not statistically significant, with a cESD-TURBT of 49.0 ± 21.0 min and a cTURBT of 44.3 ± 23.8 min (p = 0.127).

Our analysis revealed that, compared with cTURBT, cESD-TURBT significantly lowers recurrence rates and is associated with fewer postoperative complications. Our study revealed that cESD-TURBT is superior to cTURBT for bladder tumor removal.