Department of Urology, Spital Thurgau AG, Kantonsspital Frauenfeld, Pfaffenholzstrasse 4, CH 8501, Frauenfeld, Switzerland.
Division of Urology, Department of Surgical Sciences, Stellenbosch University, Western Cape, South Africa.
World J Urol. 2023 Oct;41(10):2577-2582. doi: 10.1007/s00345-023-04629-z.
En bloc resection of bladder tumors (ERBT) orginally described in 1980 and adopted by few centers in the late 1990s has regained attention in the 2010s as a renaissance of a technique with high potential. The advent of new lasers indirectly lead to a better understanding of anatomical dissection from the experience in anatomical dissection in endoscopic enucleation of the prostate. 12 years after the reintroduction of ERBT evidence mounts that it is not only equivalent but better in some regards. However, ERBT still falls short with regard to wide adoption despite the striking technique inherent and reproducible features of accurate staging and specimen quality as requested by pathologist, as well and despite the high intraoperative safety and fast adoption of this technique even in early phase of training. The editorial walks the reader through the timeline of the renaissance speculating why there is a blockage between cognitive understanding and dissonance in surgical practice. The special issues presents the meta-analysis of surgical and oncological data on one hand and the level of understanding and power of this surgical technique in fields offsite oncological results in training achieving results almost right from the start after adoptation. Unlike in earlier years reviewing the literature of ERBT in 2023, ERBT seems not only to be a viable alternative, but something one should turn towards no to underperform with regards to the endpoints achievable by ERBT in a critical disease like bladder cancer.
整块膀胱肿瘤切除术（ERBT）最初于 1980 年描述，并于 20 世纪 90 年代末被少数中心采用，在 21 世纪 10 年代作为一种具有高潜力的技术复兴重新受到关注。新激光的出现间接导致了对解剖分离的更好理解，这是从前列腺内镜剜除术的解剖分离经验中获得的。在 ERBT 重新引入 12 年后，有证据表明，它不仅在某些方面是等效的，而且更好。然而，尽管 ERBT 具有内在的显著技术特点和可重现的准确分期和标本质量特征，符合病理学家的要求，并且尽管该技术具有术中安全性高且易于在培训早期采用，但它的广泛应用仍存在不足。该社论引导读者了解复兴的时间线，并推测为什么在认知理解和手术实践之间存在障碍。特刊一方面呈现了手术和肿瘤学数据的荟萃分析，另一方面也呈现了对该手术技术的理解水平和力量，以及在培训中远离肿瘤学结果领域的应用效果，在采用后几乎立即取得了成果。与 2023 年回顾 ERBT 文献的早期不同，ERBT 似乎不仅是一种可行的替代方案，而且对于膀胱癌等严重疾病，ERBT 所能达到的终点，人们应该转而采用这种方法，而不是表现不佳。
