膀胱肿瘤整体切除术（En Bloc）与常规经尿道切除术（cTURBT）：一项系统综述与Meta分析肿瘤学、组织病理学及手术结局

膀胱肿瘤整体切除术（ERBT）旨在提高膀胱癌的切除质量。本综述旨在比较ERBT与传统的经尿道膀胱肿瘤切除术（cTURBT）在围手术期和肿瘤学结局方面的差异。我们通过PubMed/Medline、Embase和Web of Science数据库检索了截至2024年5月发表的随机对照试验。主要结局为复发和进展风险，次要结局包括逼近肌层（DM）的检测率、粘膜肌层（MM）可见性、膀胱穿孔率、闭孔神经反射率、手术时间、导管插入时间、住院时间及重复膀胱肿瘤经尿道切除术（reTURBT）后残留肿瘤。共纳入17项研究。结果显示，在12个月复发率（风险比[RR] 0.81, 95%置信区间[CI]：0.65-1.02; p=0.08）、24个月复发率（RR 1.02, 95% CI：0.85-1.22; p=0.8）以及12个月进展率（RR 0.68, 95% CI：0.05-10.14; p=0.8）方面，差异无统计学意义。ERBT显著提高逼近肌层（DM）检测率（RR 1.10, 95% CI：1.01-1.20; p=0.02），而在reTURBT残余肿瘤和MM可见性方面无明显差异（全部p>0.05）。ERBT显著降低膀胱穿孔（p=0.002）和闭孔神经反射（p<0.001）发生率。除此之外，ERBT还显著延长手术时间、降低导管留置时间和住院天数。主要局限在于纳入研究的异质性。ERBT在手术安全性方面优于cTURBT，且未在肿瘤学结局上表现出明显差异。较高的逼近肌层检测率有助于改善早期疾病分层，潜在提升临床决策与护理质量。整体而言，整体切除术在减少术中并发症和提供更佳组织学信息方面优于传统技术，但肿瘤特性、手术医生经验及术后护理等因素仍对后续事件产生重要影响。

En bloc resection of bladder tumor (ERBT) has been introduced to enhance the quality of resection of bladder cancer. This review aims to compare the perioperative and oncological outcomes of ERBT and conventional transurethral resection of bladder tumor (cTURBT).A literature search was conducted using the PubMed/Medline, Embase, and Web of Science databases to identify randomized controlled trials published until May 2024. The primary outcomes were the risk of recurrence and progression. The secondary outcomes were detrusor muscle (DM) presence, muscularis mucosae (MM) detectability, bladder perforation and obturator nerve reflex rates, operative time, length of catheterization and hospitalization, and residual tumor at repeat transurethral resection of bladder tumor (reTURBT).Seventeen studies met our inclusion criteria. No statistically significant difference was observed in 12-mo recurrence (risk ratio [RR] 0.81, 95% confidence interval [CI]: 0.65-1.02; p = 0.08), 24-mo recurrence (RR 1.02, 95% CI: 0.85-1.22; p = 0.8), and 12-mo progression (RR 0.68, 95% CI: 0.05-10.14; p = 0.8) rates. ERBT was significantly associated with a higher DM presence (RR 1.10, 95% CI: 1.01-1.20; p = 0.02), while no statistically significant difference emerged in the residual tumor at reTURBT and MM detectability (all p > 0.05). ERBT was significantly associated with a lower risk of bladder perforation (p = 0.002) and obturator nerve reflex (p < 0.001). Finally, ERBT was significantly associated with longer operative time, lower catheterization time, and lower length of hospital stay. The main limitation was heterogeneity among the included studies.ERBT is safer due to fewer intraoperative events, but there was no significant difference in oncological outcomes compared with cTURBT. Higher DM detection with ERBT enhances initial disease stratification, potentially improving clinical decision-making and care delivery.En bloc resection of bladder tumors is associated with lower intraoperative complications than and superior histopathological information to the conventional resection technique. However, the absence of a difference in oncological outcomes underscores the influence of factors such as tumor characteristics, surgeon expertise, and postoperative care on subsequent events.