En Bloc Resection Versus Conventional TURBT for T1HG Bladder Cancer: A Propensity Score-Matched Analysis.

We aimed to assess the clinical, oncological, and pathological impact of en bloc resection of bladder tumors (ERBT) compared with conventional transurethral resection of bladder tumors (cTURBT) for pT1 high-grade (HG) bladder cancer.

We retrospectively analyzed the record of 326 patients (cTURBT: n = 216, ERBT: n = 110) diagnosed with pT1 HG bladder cancer at multiple institutions. The cohorts were matched by one-to-one propensity scores based on patient and tumor demographics. Recurrence-free survival (RFS), progression-free survival (PFS), cancer-specific survival (CSS), and perioperative and pathologic outcomes were compared. The prognosticators of RFS and PFS were analyzed using the Cox proportional hazard model.

After matching, 202 patients (cTURBT: n = 101, ERBT: n = 101) were retained. There were no differences in perioperative outcomes between the two procedures. The 3-year RFS, PFS, and CSS were not different between the two procedures (p = 0.7, 1, and 0.7, respectively). Among patients who underwent repeat transurethral resection (reTUR), the rate of any residue on reTUR was significantly lower in the ERBT group (cTURBT: 36% versus ERBT: 15%, p = 0.029). Adequate sampling of muscularis propria (83% versus 93%, p = 0.029) and diagnostic rates of pT1a/b substaging (90% versus 100%, p < 0.001) were significantly better in ERBT specimen compared with cTURBT specimen. On multivariable analyses, pT1a/b substaging was a prognosticator of disease progression.

In patients with pT1HG bladder cancer, ERBT had similar perioperative and mid-term oncologic outcomes compared with cTURBT. However, ERBT improves the quality of resection and specimen, yielding less residue on reTUR and yielding superior histopathologic information such as substaging.

Annals of surgical oncology. 2023 Mar 10 [Epub ahead of print]

Takafumi Yanagisawa, Akihiro Matsukawa, Kosuke Iwatani, Shun Sato, Yasushi Hayashida, Yohei Okada, Takashi Yorozu, Wataru Fukuokaya, Keigo Sakanaka, Fumihiko Urabe, Shoji Kimura, Shunsuke Tsuzuki, Masayuki Shimoda, Hiroyuki Takahashi, Jun Miki, Shahrokh F Shariat, Takahiro Kimura

Department of Urology, The Jikei University School of Medicine, Tokyo, Japan., Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan., Department of Urology, National Hospital Organization Ureshino Medical Center, Saga, Japan., Department of Urology, Saitama Medical Center, Saitama, Japan., Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan., Department of Urology, The Jikei University School of Medicine, Tokyo, Japan. ., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.