Perioperative Safety and Long-Term Oncological Outcomes of En Bloc Resection of Bladder Tumor: A Multicenter Real-World Study of 668 Patients.

OBJECTIVES: To evaluate perioperative safety, pathological outcomes, and oncological outcomes of en bloc resection of bladder tumor (ERBT) in a large multicenter real-world cohort. METHODS: We retrospectively analyzed 668 patients who underwent ERBT at five institutions. Perioperative and pathological outcomes were assessed in the overall cohort. Recurrence-free survival (RFS) was evaluated in patients with pathologically confirmed non-muscle-invasive bladder cancer (NMIBC) without a history of upper tract urothelial carcinoma (n = 551). Clinicopathological prognosticators of recurrence were identified using Cox proportional hazards regression. RESULTS: The median age was 73 years, and the median maximum tumor diameter was 15 mm. The median operative time and postoperative catheterization period were 48 min and 3 days, respectively. Perioperative complications occurred in 60 patients (9.0%), including eight (1.2%) with Clavien-Dindo Grade III or higher complications. Detrusor muscle was identified in 77.2% of evaluable specimens. Final pathology showed pTa, pT1, pTis, and pT2 disease in 377 (56.4%), 239 (35.8%), 16 (2.4%), and 25 patients (3.7%), respectively. With a median follow-up of 42 months, the estimated 1-, 2-, and 5-year RFS rates were 80.9%, 73.2%, and 57.1%, respectively. RFS did not differ significantly between pTa and pT1 disease (log-rank p = 0.39). Patients presenting with recurrent tumors had a significantly higher risk of subsequent intravesical recurrence than those with primary tumors (HR 2.06, 95% CI 1.38-3.07; p < 0.001). CONCLUSIONS: ERBT demonstrated favorable perioperative safety and acceptable oncological outcomes in this large multicenter cohort. Post-ERBT recurrence remained strongly influenced by prior recurrence history, highlighting the importance of risk-adapted postoperative management.