An International Collaborative Consensus Statement on En Bloc Resection of Bladder Tumour Incorporating Two Systematic Reviews, a Two-round Delphi Survey, and a Consensus Meeting

There has been increasing interest in en bloc resection of bladder tumour (ERBT) as an oncologically noninferior alternative to transurethral resection of bladder tumour (TURBT) with fewer complications and better histology specimens. However, there is a lack of robust randomised controlled trial (RCT) data for making recommendations. We aimed to develop a consensus statement to standardise various aspects of ERBT for clinical practice and to guide future research. We developed the consensus statement on ERBT using a modified Delphi method. First, two systematic reviews were performed to investigate the clinical effectiveness of ERBT versus TURBT (effectiveness review) and to identify areas of uncertainty in ERBT (uncertainties review). Next, 200 health care professionals (urologists, oncologists, and pathologists) with experience in ERBT were invited to complete a two-round Delphi survey. Finally, a 16-member consensus panel meeting was held to review, discuss, and re-vote on the statements as appropriate. Meta-analyses were performed for RCT data in the effectiveness review. Consensus statements were developed from the uncertainties review. Consensus was defined as follows: (1) ≥70% scoring a statement 7–9 and ≤15% scoring the statement 1–3 (consensus agree), or (2) ≥70% scoring a statement 1–3 and ≤15% scoring the statement 7–9 (consensus disagree). A total of 10 RCTs were identified upon systematic review. ERBT had a shorter irrigation time (mean difference –7.24 h, 95% confidence interval [CI] –9.29 to –5.20, I2 = 85%, p