AUA 2023: Transurethral En Bloc Resection versus Standard Resection of Bladder Tumor: A Multi-Center Randomized Trial (EB-StaR Study)

(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).

EB-StaR.jpg 

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.

AUA EB-StaR.jpg

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