Transurethral resection of bladder tumor (TURBT) remains the basis of bladder tumor diagnosis and an effective means of treating nonmuscle invasive bladder cancer (NMIBC). There are several limitations to this procedure: TURBT may cause free floating of malignant cells in the bladder and as a result re-implantation and early recurrence. Also, it does not allow the pathologist to define the correct spatial orientation of the specimen. The development of en bloc resection of bladder tumor (ERBT) has helped overcome the abovementioned key disadvantages of TURBT. However, many urologists doubt whether this approach is feasible for treating larger tumors.
In this review, it is shown that ERBT of large bladder tumor (>3 cm) is in fact a feasible and well tolerated method. Although there is a lack of comparative data proving its advantages over TURBT, en bloc in large tumor seems to result in better local cancer control (due to higher prevalence of detrusor specimen, lower need for re-TURBT), lower rate of relapse outside the resection area (due to lower risk of tumor cells circulation), and higher quality of pathology specimen.
Despite the skepticism of some surgeons, potential difficulties caused by larger tumor size may be overcome easily, and most agree that tumor size should not limit the implementation of the method in their daily practice.
Current opinion in urology. 2025 Jan 21 [Epub ahead of print]
Diana Babaevskaya, Andrey Morozov, Eddie Fridman, Larisa Tsoy, Shahrokh F Shariat, Yossef Molchanov, Maxim Yakimov, Eva Compérat, Thomas R W Herrmann, Dmitry Enikeev
Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia., Department of Diagnostic Pathology, Sheba Medical Center, Ramat Gan., Institute for Clinical Morphology and Digital Pathology, Sechenov University, Moscow, Russia., Pathology Department, Rabin Medical Center, Petah Tikva, Israel., Department of Pathology, Hôpital Tenon, Sorbonne Université, Paris, France., Department of Urology, Spital Thurgau AG, Kantonspital Frauenfeld, Frauenfeld, Switzerland.