膀胱肿瘤的En Bloc与常规的尿道切除术：肿瘤，组织病理学和手术结局的系统评价和荟萃分析

引入了膀胱肿瘤（ERBT）的整体切除，以提高膀胱癌切除质量。这篇评论旨在比较ERBT的围手术期和肿瘤学结果以及膀胱肿瘤的常规尿道切除（Cturbt）。使用PubMed/Medline，Embase和Science Database进行了文献搜索，以识别2024年5月发表的随机对照试验，直到2024年5月。次要结果是肌肉肌肉（DM）的存在，Muscularis Mucosae（MM）可检测性，膀胱穿孔和闭孔神经反射率，手术时间，导管的长度，导管的长度，住院时间和残留肿瘤以及在膀胱肿瘤的重复术中进行外尿（reterbert tumor）（reteventeen tumor）。 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）。 ERBT与较高的DM存在显着相关（RR 1.10，95％CI：1.01-1.20; P = 0.02），而在returbt和MM可检测性的残留肿瘤中没有统计学上的显着差异（所有P> 0.05）。 ERBT与膀胱穿孔（P = 0.002）和闭孔神经反射（P <0.001）的较低风险显着相关。最后，ERBT与更长的手术时间，较低的导管时间和较低的住院时间显着相关。主要的限制是纳入的研究中的异质性。由于术中事件的较少，ERBT更安全，但是与Cturbt相比，肿瘤学结局没有显着差异。使用ERBT的DM检测较高可增强初始疾病分层，可能改善临床决策和护理的分娩。膀胱肿瘤的集合切除术与术中并发症低于较低的术中并发症，并且与常规切除技术相比，较高的组织病理学信息与较高的组织病理学信息有关。但是，肿瘤学结果的缺乏强调了肿瘤特征，外科医生专业知识和术后护理等因素对随后事件的影响。

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.