Efficacy analysis of transurethral en bloc resection for bladder tumors ≥3 cm

En bloc resection of bladder tumors (ERBT) is a surgical treatment for non-muscle-invasive bladder cancer (NMIBC). However, data on the efficacy and safety of ERBT for tumors ≥3 cm are limited. This study aimed to investigate the technical characteristics and clinical application of β-electrode ERBT in the treatment of bladder tumors ≥3 cm and analyze its feasibility and short-term safety.

Retrospective data were collected from patients with bladder cancer (BC) who underwent β-electrode ERBT between 2021 and 2024. Surgical Procedure: A mark was made 0.5 cm from the tumor margin. The knife tip was inserted into the submucosal layer at the marked site and retracted away from the bladder wall. The tumor was completely resected using a combination of hook dissection and blunt separation, followed by removal. For larger tumors, en bloc resection was also performed, after resecting most of the tumor base, a small portion was left attached to the bladder wall (to suspend the tumor on the bladder wall and prevent it from becoming free-floating). Subsequently, the tumor crown was crushed and aspirated using a tissue morcellator, while the preserved tumor base was removed en bloc for pathological examination. The primary endpoints recorded were recurrence-free survival (RFS) and progression-free survival (PFS), with secondary endpoints including detrusor muscle (DM) presence rate (presence of muscularis propria in specimens) and safety (intraoperative and postoperative complications).

This study enrolled 102 patients with tumor size ≥3 cm. The median operative time was 50.0 (IQR: 34.5, 90.0) minutes, with 73 (71.6%) cases involving DM. No obturator nerve reflex occurred intraoperatively in any patient. Postoperative complications were observed in 10 patients, among which urinary tract infection was the most common (n=5). During a median follow-up of 22.5 (IQR: 14.0, 29.3) months, 10 recurrences and 4 progressions were recorded. The 2-year RFS and 2-year PFS were 90.2% and 96.9%, respectively.

β-electrode ERBT is a selective surgical approach for bladder tumors ≥3 cm, demonstrating favorable short-term efficacy with minimal intraoperative and postoperative complications, and a good short-term oncological prognosis after surgery.