Comparison between En bloc Resection and conventional resection of bladder tumor in perioperative and oncological outcomes

Purpose: Conventional transurethral resection of bladder tumors (cTURBT) has been the main technique for treating visible bladder tumor for decades. However, the reported rate of detrusor muscle presence in cTURBT specimen was lower than 80%, which is associated with imprecise staging and poor prognosis. Here, we present a retrospective analysis to compare the detrusor muscle detection rate and outcomes between en bloc resection of bladder tumor (ERBT) and cTURBT.Materials and Methods: Between January 2016 and December 2019, a total of 150 procedures performed by single surgeon in single institute were reviewed in this study. Of these procedures, 41 (27.3%) were ERBT and 109 (72.6%) were cTURBT. The two techniques were compared for pathological detrusor muscle detection, history of upper tract urothelial cancer, number of tumor lesions, histopathological grading and staging, time of operation, and time of catheterization and hospitalization.Results: The muscularis propria detection rate was statistically significantly higher in the ERBT group than in the cTURBT group (82.9% vs. 43.1%, P < 0.0001). The multivariate analysis showed resection method as an independent factor of detrusor muscle presentation (P < 0.0001). The mean Foley catheter indwelling and hospitalization days were longer in the ERBT group but were only 1 day longer than in the cTURBT group. Conclusions: ERBT significantly increases the muscularis propria detection rate than cTURBT. ERBT can provide more accurate cancer staging and contribute to proper decision-making. This study strengthens ERBT as a feasible and promising management of bladder cancer.