En bloc resection of bladder tumour: the rebirth of past through reminiscence

PurposeTo learn about the history and development of en bloc resection of bladder tumour (ERBT), and to discuss its future directions in managing bladder cancer.MethodsIn this narrative review, we summarised the history and early development of ERBT, previous attempts in overcoming the tumour size limitation, consolidative effort in standardising the ERBT procedure, emerging evidence in ERBT, evolving concepts in treating large bladder tumours, and the future directions of ERBT.ResultsSince the first report on ERBT in 1980, there has been tremendous advancement in terms of its technique, energy modalities and tumour retrieval methods. In 2020, the international consensus statement on ERBT has been developed and it serves as a standard reference for urologists to practise ERBT. Recently, high-quality evidence on ERBT has been emerging. Of note, the EB-StaR study showed that ERBT led to a reduction in 1-year recurrence rate from 38.1 to 28.5%. An individual patient data meta-analysis is currently underway, and it will be instrumental in defining the true value of ERBT in treating non-muscle-invasive bladder cancer. For large bladder tumours, modified approaches of ERBT should be accepted, as the quality of resection is more important than a mere removal of tumour in one piece. The global ERBT registry has been launched to study the value of ERBT in a real-world setting.ConclusionERBT is a promising surgical technique in treating bladder cancer and it has gained increasing interest globally. It is about time for us to embrace this technique in our clinical practice.

Automated summary

This article summarizes the history and development of en bloc resection of bladder tumour (ERBT) and discusses its future directions in managing bladder cancer. Since its first report in 1980, there have been significant advancements in the techniques, energy modalities, and tumor retrieval methods of ERBT. The international consensus statement on ERBT has been developed as a standard reference for urologists, and high-quality evidence on ERBT is emerging. Modified approaches of ERBT should be used for large bladder tumors, and the global ERBT registry has been launched to study its value in a real-world setting.