En-bloc resection of bladder tumour as primary treatment for patients with non-muscle-invasive bladder cancer: routine implementation in a multi-centre setting

Purpose To investigate the technical success rate and 30-day complications of en-bloc resection of bladder tumour (ERBT) upon routine implementation regardless of tumour size. Methods This is a prospective, multi-centre, study on routine implementation of ERBT for patients with bladder tumours requiring transurethral surgery. Surgeons were allowed to cross over to conventional transurethral resection of bladder tumour (TURBT) when necessary. We performed an analysis for patients who had ERBT/TURBT as the definitive treatment. Study outcomes included the technical success rate of ERBT and 30-day complication rate. Multivariate logistic regression analysis was performed to investigate for predictors of a successful ERBT and factors associated with 30-day complications. Results A total of 135 patients were included in this study. The majority of the patients (80.0%) had bladder tumours of <= 3 cm. ERBT was successful in 99 patients, resulting in an overall technical success rate of 73.3%. When stratified according to tumour size, the technical success rates of ERBT were 94.3%, 82.2%, 75%, 84.3% and 29.6% for bladder tumour sizes of < 1 cm, 1.01-2 cm, 2.01-3 cm, <= 3 cm and > 3 cm respectively. Upon multivariate analysis, tumour size was the only significant factor predicting the success of ERBT (OR 0.920, 95% CI 0.882-0.960, p < 0.001). Moreover, ERBT was not a significant factor associated with 30-day complications. Conclusion EBRT achieved a good technical success rate for the majority of patients with bladder tumours <= 3 cm. Regardless of tumour size, EBRT-first approach was safe to implement into routine clinical practice.