CUHK review informs international collaborative consensus statement on en bloc resection of bladder tumour

Researchers from The Chinese University of Hong Kong carried out two systematic reviews of 10 randomized clinical trials (RCTs), which compared the effectiveness of en bloc resection of bladder tumour (ERBT) as an oncologically noninferior alternative to transurethral resection of bladder tumour (TURBT). In-depth RCT meta-analyses were followed by a two-round Delphi survey of >100 respondents with ERBT experience and a 16-member expert panel meeting, which culminated in the publication of a consensus statement addressing every aspect of ERBT.

“Although urologists are aware of the advantages of ERBT in treating bladder cancer, there is a global lack of recommendations for this surgical procedure,” said Dr Jeremy Teoh from the Division of Urology, Department of Surgery at CUHK. “CUHK has carried out the most comprehensive review of scientific evidence on ERBT to date, which has served as the basis for an international collaborative consensus statement on the procedure.”

A summary of statements concluded that ERBT should always be considered for treating non-muscle–invasive bladder cancer; ERBT should be considered feasible even for bladder tumours >3 cm; number and location of bladder tumours are not major limitations to performing ERBT; the planned circumferential margin should be ≥5 mm from any visible bladder tumour; after ERBT, additional biopsy of the tumour edge or tumour base should not be performed routinely; for the ERBT specimen, T1 substage, and circumferential and deep resection margins must be assessed; it is safe to give a single dose of immediate intravesical chemotherapy, to perform second-look transurethral resection, and give intravesical bacillus Calmette-Guérin (BCG) therapy after ERBT; and in studies of ERBT, both per-patient and per-tumour analysis should be performed for different outcomes as appropriate. [Eur Urol 2020;78:546-569]

“The consensus statement will provide guidance for healthcare professionals who practice ERBT and inform researchers regarding ERBT-related studies in the future. Treatment for bladder cancer depends on its type, patients’ medical history and their personal preferences. Therefore, we suggest patients have a thorough discussion with their doctors on the best treatment option,” recommended Teoh.