Can a reresection be avoided after initial resection for high-risk nonmuscle invasive bladder cancer? A systematic review and meta-analysis.

Background: This study aims to evaluate the effectiveness of resection for patients with nonmuscle invasive bladder cancer (NMIBC) and explore whether a reresection can be avoided after initial resection.

Material And Methods: We conducted research in PubMed, EMBASE, Cochrane Library, and Web of Science up to October 12, 2021, to identify studies on the second resection after initial resection of bladder tumor (ERBT). R software and the double arcsine method were used for data conversion and combined calculation of the incidence rate.

Results: A total of 8 studies involving 414 participants were included. The rate of detrusor muscle in the ERBT specimens was 100% (95%CI: 100%-100%), the rate of tumor residual in reresection specimens was 3.2% (95%CI: 1.4%-5.5%), and the rate of tumor upstaging was 0.3% (95%CI: 0%-1.5%). Two articles compared the prognostic data of the reresection and non-reresection groups after the initial ERBT. We found no significant difference in the 1-year recurrence-free survival (RFS) rate (OR = 1.44, 95%CI: 0.67-3.09,  = 0.35) between the two groups nor in the rate of tumor recurrence (OR = 0.72, 95%CI: 0.44-1.18,  = 0.2) or progression (OR = 0.98, 95%CI: 0.33-2.89,  = 0.97) at the final follow-up.

Conclusions: ERBT can almost completely remove the detrusor muscle of the tumor bed with a very low postoperative tumor residue and upstaging rate. For high-risk NMIBC patients, an attempt to appropriately reduce the use of reresection after ERBT seems to be possible.