The impact of transurethral en bloc resection of bladder tumour on pathological and oncological outcomes

Abstract

Transurethral resection of bladder tumour (TURBT) is the current gold standard in managing non-muscle invasive bladder cancer (NMIBC), but it is associated with suboptimal pathological and oncological outcomes. There are two main problems with TURBT. First, it is difficult to ascertain complete tumour removal upon piecemeal resection. Second, tumour fragmentation upon resection may lead to increased risk of tumour re-implantation. En bloc resection of bladder tumour (ERBT) has been proposed to tackle these problems. First, it allows full resection of the tumour in one piece including the underlying detrusor muscle, hence providing better evaluation of the resection margins and local staging. As tumours can be completely resected with clear margins, residual disease is less likely with this technique. Second, ERBT avoids manipulation and fragmentation of the bladder tumour, hence minimizing the amount of floating cells and reducing the risk of tumour re-implantation after the surgery. By upholding oncological principles as much as possible, oncological outcomes of NMIBC may be optimised. The future of ERBT is promising in providing better pathological and oncological outcomes, but larger randomised controlled trials are crucial in establishing solid evidence in clinically important outcomes and answering some technical uncertainties regarding ERBT.