En-bloc Resection of Bladder Tumor Versus Conventional Transurethral Resection of Bladder Tumor: Long-term...

Prior randomized trials have shown that en bloc transurethral resection of bladder tumor (ERBT) is noninferior to conventional transurethral resection of bladder tumor (cTURBT) for pathological staging. To address gaps in long-term oncologic outcomes, we conducted a post hoc analysis of a single-center randomized trial including 219 of the 248 patients treated between 2018 and 2021, evaluating overall survival (OS), cancer-specific survival (CSS), and cumulative incidence of urothelial recurrence with a median follow-up of 60 mo (interquartile range = 53-79). ERBT was performed in 124 patients (57%) and cTURBT in 95 (43%). Overall, 77 patients experienced recurrence. With updated follow-up, 60-mo cumulative urothelial recurrence rates ranged from 8% (95% confidence interval [CI] = 2-14) for cTURBT to 10% (95% CI = 5-18) for ERBT. Even after competing-risk multivariable adjustment for overall mortality, as well as age, sex, tumor stage and grade, comorbidities (hypertension and diabetes mellitus), prior bladder tumor, and adjuvant therapy, recurrence rates did not differ between ERBT and cTURBT. Rates of upgrading (low grade to high grade) and upstaging (Tx/Ta/T1-T2) were also similar between groups. During follow-up, 41 patients died, including 5 bladder cancer-related deaths; 60-month OS was 76% (95% CI = 68-86) for cTURBT and 83% (95% CI = 76-90) for ERBT, with no difference in 60-mo CSS (97% vs 97%).