En Bloc Resection for Bladder Tumors: An Updated Systematic Review and Meta-Analysis of Its Differential Effect on Safety, Recurrence and Histopathology

No AccessJournal of UrologyReview Articles1 Apr 2022En Bloc Resection for Bladder Tumors: An Updated Systematic Review and Meta-Analysis of Its Differential Effect on Safety, Recurrence and Histopathology Takafumi Yanagisawa, Keiichiro Mori, Reza Sari Motlagh, Tatsushi Kawada, Hadi Mostafaei, Fahad Quhal, Ekaterina Laukhtina, Pawel Rajwa, Abdulmajeed Aydh, Frederik König, Maximilian Pallauf, Benjamin Pradere, David D'Andrea, Eva Compérat, Jun Miki, Takahiro Kimura, Shin Egawa, and Shahrokh F. Shariat Takafumi YanagisawaTakafumi Yanagisawa https://orcid.org/0000-0002-7410-0712 Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Department of Urology, Jikei University School of Medicine, Tokyo, Japan , Keiichiro MoriKeiichiro Mori Department of Urology, Jikei University School of Medicine, Tokyo, Japan , Reza Sari MotlaghReza Sari Motlagh Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran , Tatsushi KawadaTatsushi Kawada Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan , Hadi MostafaeiHadi Mostafaei Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran , Fahad QuhalFahad Quhal Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia , Ekaterina LaukhtinaEkaterina Laukhtina Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia , Pawel RajwaPawel Rajwa Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Department of Urology, Medical University of Silesia, Zabrze, Poland , Abdulmajeed AydhAbdulmajeed Aydh Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Department of Urology, King Faisal Medical City, Abha, Saudi Arabia , Frederik KönigFrederik König Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany , Maximilian PallaufMaximilian Pallauf Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Department of Urology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria , Benjamin PradereBenjamin Pradere Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria , David D'AndreaDavid D'Andrea Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria , Eva CompératEva Compérat Department of Pathology, Medical University of Vienna, Vienna, Austria , Jun MikiJun Miki Department of Urology, Jikei University School of Medicine, Tokyo, Japan , Takahiro KimuraTakahiro Kimura Department of Urology, Jikei University School of Medicine, Tokyo, Japan , Shin EgawaShin Egawa Department of Urology, Jikei University School of Medicine, Tokyo, Japan , and Shahrokh F. ShariatShahrokh F. Shariat *Correspondence: Department of Urology, Medical University of Vienna, Wahringer Gurtel 43 18-20, 1090Vienna , Austria telephone: +4314040026150; FAX: +4314040023320; E-mail Address: [email protected] Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia View All Author Informationhttps://doi.org/10.1097/JU.0000000000002444AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: En bloc resection for bladder tumors has been developed to overcome shortcomings of conventional transurethral resection of bladder tumors with regard to safety, pathological evaluation and oncologic outcomes. However, the potential benefits and utility compared to conventional transurethral resection of bladder tumors have not been conclusively demonstrated. We aimed to update the current evidence with focus on the pathological benefits of en bloc resection for nonmuscle-invasive bladder cancer. Materials and Methods: The PubMed®, Web of Science™ and Scopus® databases were searched in August 2021 according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement. Studies were deemed eligible if they compared safety, and pathological and clinical outcomes in patients who underwent en bloc resection with conventional transurethral resection of bladder tumors. Results: Overall, 29 studies comprising 4,484 patients were eligible for this meta-analysis. Among 13 randomized controlled trials, the pooled 12- and 24-month recurrence risk ratios were not statistically different between the 2 surgical techniques (0.96, 95% CI 0.74–1.23 and 0.83, 95% CI 0.55–1.23, respectively). The pooled risk ratio for bladder perforation was 0.13 (95% CI 0.05–0.34) in favor of en bloc resection. In randomized controlled trials, the differential rates of detrusor muscle presence (pooled RR 1.31, 95% CI 1.19–1.43) and of detectable muscularis mucosae (pooled RR 2.69, 95% CI 1.81-3.97) were more likely in patients receiving en bloc resection. Patients who underwent en bloc resection had a lower rate of residual tumor at repeat transurethral resection than those treated with conventional transurethral resection of bladder tumors in 1 randomized controlled trial and 3 observational studies (pooled RR 0.47, 95% CI 0.31–0.71). Conclusions: En bloc resection for bladder tumors seems to be safer, and to yield superior histopathological information and performance compared to conventional transurethral resection of bladder tumors. Despite the failure to improve the recurrence rate, the more accurate histopathological analysis is likely to improve clinical decision making and care delivery in nonmuscle-invasive bladder cancer. 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Consulting or Advisory Role: Astellas, AstraZeneca, BMS, Ferring, Ipsen, Janssen, MSD, Olympus, Pfizer, Pierre Fabre, Roche, Takeda. Speakers Bureau: Astellas, Astra Zeneca, Bayer, BMS, Ferring, Ipsen, Janssen, MSD, Olympus, Pfizer, Richard Wolf, Roche, Takeda. Takahiro Kimura is a paid consultant/advisor of Astellas, Bayer, Janssen and Sanofi. The other authors declare no conflicts of interest associated with this manuscript. Ethics Statement: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Author Contributions: TY contributed to protocol/project development, data collection and management, data analysis and manuscript writing/editing. KM, RSM, TK contributed to data analysis and manuscript writing/editing. HM, FQ, EL, PR, AA, FK, MP and BP contributed to manuscript writing/editing. DD, EC, JM, TK and SE contributed to manuscript editing. SFS contributed to protocol/project development/management and manuscript editing. © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue 4April 2022Page: 754-768Supplementary Materials PEER REVIEW REPORT Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.Keywordspathologyurinary bladder neoplasmsrecurrenceMetricsAuthor Information Takafumi Yanagisawa Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Department of Urology, Jikei University School of Medicine, Tokyo, Japan More articles by this author Keiichiro Mori Department of Urology, Jikei University School of Medicine, Tokyo, Japan More articles by this author Reza Sari Motlagh Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran More articles by this author Tatsushi Kawada Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan More articles by this author Hadi Mostafaei Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran More articles by this author Fahad Quhal Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia More articles by this author Ekaterina Laukhtina Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia More articles by this author Pawel Rajwa Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Department of Urology, Medical University of Silesia, Zabrze, Poland More articles by this author Abdulmajeed Aydh Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Department of Urology, King Faisal Medical City, Abha, Saudi Arabia More articles by this author Frederik König Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany More articles by this author Maximilian Pallauf Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Department of Urology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria More articles by this author Benjamin Pradere Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria More articles by this author David D'Andrea Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria More articles by this author Eva Compérat Department of Pathology, Medical University of Vienna, Vienna, Austria More articles by this author Jun Miki Department of Urology, Jikei University School of Medicine, Tokyo, Japan More articles by this author Takahiro Kimura Department of Urology, Jikei University School of Medicine, Tokyo, Japan More articles by this author Shin Egawa Department of Urology, Jikei University School of Medicine, Tokyo, Japan More articles by this author Shahrokh F. Shariat Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia *Correspondence: Department of Urology, Medical University of Vienna, Wahringer Gurtel 43 18-20, 1090Vienna , Austria telephone: +4314040026150; FAX: +4314040023320; E-mail Address: [email protected] More articles by this author Expand All Support: No external funding provided. Conflict of Interest: Shin Egawa is a paid consultant/advisor of Takeda, Astellas, AstraZeneca, Sanofi, Janssen and Pfizer. Shahrokh F. Shariat is paid as follows: Honoraria: Astellas, AstraZeneca, BMS, Ferring, Ipsen, Janssen, MSD, Olympus, Pfizer, Roche, Takeda. Consulting or Advisory Role: Astellas, AstraZeneca, BMS, Ferring, Ipsen, Janssen, MSD, Olympus, Pfizer, Pierre Fabre, Roche, Takeda. Speakers Bureau: Astellas, Astra Zeneca, Bayer, BMS, Ferring, Ipsen, Janssen, MSD, Olympus, Pfizer, Richard Wolf, Roche, Takeda. Takahiro Kimura is a paid consultant/advisor of Astellas, Bayer, Janssen and Sanofi. The other authors declare no conflicts of interest associated with this manuscript. Ethics Statement: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Author Contributions: TY contributed to protocol/project development, data collection and management, data analysis and manuscript writing/editing. KM, RSM, TK contributed to data analysis and manuscript writing/editing. HM, FQ, EL, PR, AA, FK, MP and BP contributed to manuscript writing/editing. DD, EC, JM, TK and SE contributed to manuscript editing. SFS contributed to protocol/project development/management and manuscript editing. Advertisement PDF DownloadLoading ...