(UroToday.com) The 2022 American Urological Association (AUA) Annual Meeting included a session on non-invasive bladder cancer and a presentation by Dr. Alberto Breda discussing results of a single-center randomized trial assessing en-bloc versus conventional transurethral resection of bladder tumors (TURBT). TURBT is considered the gold standard in the diagnosis and risk stratification of bladder cancer. En-bloc resection of bladder tumor has been proposed to improve resection quality:
Recently, the International Collaborative Consensus Statement on en-bloc resection of bladder tumor underlined the lack of high-quality prospective studies precluding the achievement of solid conclusion on en-bloc resection of bladder tumor.1 The aim of this study presented by Dr. Breda and colleagues was to compare TURBT and en-bloc resection of bladder tumor in pathological diagnosis, surgical, and oncological outcomes.
This study was a prospective, randomized trial enrolling patients diagnosed with bladder cancer and undergoing endoscopic intervention. Inclusion criteria were: tumor size of ≤3 cm, and ≤3 lesions, and no sign of muscle invasion and/or ureteral involvement. The primary outcome is the staging of bladder cancer. Secondary outcomes included T1 substaging (microstaging systems T1a/b/c), intraoperative complications, rate of adjuvant treatment, postoperative complications, oncologic outcomes. With an α and β risk of 2.5% and 20% with a non-inferior difference of 5% en the rate of detrusor muscle presence, a total of 300 subjects were included in the study with 1:1.5 treatment allocation for en-bloc resection of bladder tumor.
From March 2018 to June 2021, 300 patients met inclusion criteria and 248 (82.7%) of these were underwent the assigned intervention. 108 (43.5%) and 140 (56.5%) patients were submitted to TURBT and en-bloc resection of bladder tumor. Pre-operatively, the populations were comparable, and as follows is the operative outcomes stratified by approach.
The rate of Tx disease was comparable (2.8% TURBT vs 4.3% en-bloc resection of bladder tumor). T1 substaging was feasible in 80% TURBT vs 100% en-bloc resection of bladder tumor (p=0.02). The rate of obturator nerve reflex and perforation were comparable (both p=0.2). In patients candidate to adjuvant treatment, the instillation was performed in 86% and 94% in TURBT and en-bloc resection of bladder tumor (p=0.1). Clavien-Dindo >2 complications were 2.8% vs 4.3% for TURBT and en-bloc resection of bladder tumor. Surgical, irrigation, and catheterization time were all comparable (all p>0.05). Over a median follow-up was 15 months (IQR 7-28), the 3 month recurrence rate was 0% for TURBT and 0.7% for en-bloc resection of bladder tumor (p = 1.0). The overall recurrence rate was 17.6% for TURBT versus 12.9% for en-bloc resection of bladder tumor (p = 0.3).
Dr. Breda concluded this presentation discussing results of a single-center randomized trial assessing en-bloc versus conventional TURBT with the following take-home messages:
- En-bloc resection of bladder tumor is non-inferior to TURBT in pathological, surgical, and short term oncological outcomes
- En-bloc resection of bladder tumor reported a higher rate of T1 substaging feasibility compared to TURBT
- This is the largest randomized study in this setting
Presented by: Alberto Breda, MD, Department of Urology, Fundacio Puigvert, University of Barcelona, Barcelona, Spain
Co-Authors: Pietro Diana, Matteo Fontana, Angelo Territo, Alberto Piana, Ferran Algaba, Oscar Rodriguez-Faba, Asier Marcade, Alejandra Bravo, Antonio Rosales, Josep Maria Gaya, Joan Palou, Barcelona, Spain
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2022 American Urological Association (AUA) Annual Meeting, New Orleans, LA, Fri, May 13 – Mon, May 16, 2022.
References:
- Teoh JYC, MacLennan S, Chan VWS, et al. An International Collaborative Consensus Statement on En Bloc Resection of Bladder Tumour Incorporating Two Systematic Reviews, a Two-round Delphi Survey, and a Consensus Meeting. Eur Urol. 2020 Oct;78(4):546-569.