(UroToday.com) The 2023 American Urological Association (AUA) annual meeting held in Chicago, IL, was host to a non-invasive bladder cancer podium session. Dr. Jeremy Teoh presented the results of the EB-StaR Study, a multicenter randomized trial of transurethral en bloc versus standard resection of bladder tumors.
Standard resection is conventionally performed by resecting the bladder tumor in a piecemeal fashion. En bloc resection of bladder tumors has been proposed as an alternative technique for bladder cancer patients.
The EB-StaR study is a randomized, multicenter phase 3 trial comparing en bloc versus standard resection of bladder tumors. This trial randomized adults with bladder tumor(s) of ≤3 cm to receive en bloc or standard resection. The primary study outcome was the 1-year recurrence rate. A modified intention-to-treat analysis for patients with histologically confirmed NMIBC was performed.
Between April 2017 and December 2020, a total of 350 patients were recruited. Of these 350, 276 patients were histologically confirmed to have NMIBC (en bloc resection group: 143 patients, standard resection group: 133 patients).
With regards to the primary outcome, the 1-year recurrence rates were 28.5% and 38.1% in the en bloc and standard resection groups, respectively (p=0.007).
At 1 year, disease progression was observed in 2.6% of patients in the standard resection group, compared to none in the en bloc resection group.
It bears note that patients in the en bloc resection arm had significantly longer operative times compared to the standard resection arm (33.4 versus 24.7 mins, p<0.001). No significant differences were observed in:
- Detrusor sampling rate
- Obturator reflex
- Post-operative bladder irrigation rates
- Rate of mitomycin C instillation
- Hospital length of stay
- Residual disease upon second resection
- Upstaging of disease upon second resection
- 30-day complications
In conclusion, patients with NMIBC of ≤3 cm treated with en bloc TURBT have significantly decreased 1-year recurrence rates compared to patients managed with standard resections.
Presented by: Jeremy Teoh, MBBS, FRCSEd (Urol), FCSHK, FHKAM (Surgery), Associate Professor, The Chinese University of Hong Kong, Hong Kong
Written by: Rashid K. Sayyid, MD, MSc – Society of Urologic Oncology (SUO) Clinical Fellow at The University of Toronto, @rksayyid on Twitter during the 2023 American Urological Association (AUA) Annual Meeting, Chicago, IL, April 27 – May 1, 2023
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En Bloc Resection vs. Standard Resection for Bladder Tumors: Multicenter Trial Results and Clinical Considerations - Jeremy Teoh