Current Evidence of Transurethral En-bloc Resection of Nonmuscle Invasive Bladder Cancer: Update 2016

Context: En-bloc resection of bladder tumors (ERBT) is a promising alternative to conventional transurethral resection of bladder tumor. Objective: To review the current results of ERBT. Evidence acquisition: A literature search of articles that included the keywords bladder and en bloc was performed on July 15, 2016 using PubMed/Medline. Relevant English-written original articles were considered. Data from the manuscripts were categorized focusing on recent trends on resection techniques, specimens' quality, morbidity, and recurrence. Evidence synthesis: ERBT provides high rates of detrusor muscle (> 95%) and specimens of high quality for pathological evaluation. It has not been analyzed whether second resections can therefore be avoided. All energy devices (lasers, electric cautery) have been used to perform ERBT with similar perioperative and oncological results. Data show that there is not much difference in respect of perioperative morbidity compared with conventional transurethral resection of bladder tumor; however, only a few publications used a systematic classification system. No conclusions can be drawn regarding the impact of ERBT on recurrence. Conclusions: The major advantage of ERBT is the high rate of detrusor muscle. Based on limited data, no significant differences are observed regarding perioperative morbidity and recurrence rates. Patient summary: En-bloc resection of bladder tumor is an emerging technique aimed at improving quality of surgical specimens. Available evidences suggest safety and oncologic equivalence compared with the standard transurethral resection of bladder tumor. The en-bloc resection of bladder tumors is a promising concept as an alternative to conventional transurethral resection of bladder tumors, and provides high quality specimens.