Perioperative and oncological outcomes of thulium laser-ERBT versus conventional TURBT in non-muscle invasive bladder cancer: a meta-analysis of 2,934 patients

Thulium laser en bloc resection of bladder tumors (TmL-ERBT) represents a novel surgical approach for non-muscle-invasive bladder cancer (NMIBC), but its comparative advantages over conventional transurethral resection (TURBT) remain controversial. This meta-analysis aimed to evaluate perioperative safety, surgical quality, and oncological outcomes of TmL-ERBT versus TURBT. A systematic search of PubMed, Embase, Web of Science, and Cochrane Library identified comparative studies of TmL-ERBT versus TURBT. Perioperative complications, oncological outcomes, and surgical quality indicators were analyzed. Heterogeneity was assessed using I² statistics and subgroup analysis. The study quality was evaluated using the ROB2 tool. Evidence certainty was graded using the GRADEpro GDT. Fourteen studies comprising 2,934 patients (TmL-ERBT: n = 1,395; TURBT: n = 1,539) were included. TmL-ERBT demonstrated significant advantages in perioperative outcomes: shorter catheterization time (MD: -0.71 days, P = 0.001), reduced postoperative irrigation time (MD: -8.79 h, P = 0.0004), and decreased hospitalization time (MD: -0.63 days, P = 0.006). Operation duration showed no significant difference (MD: -2.66 min, P = 0.33). Safety outcomes favored TmL-ERBT with virtual elimination of obturator nerve reflex (OR: 0.04, P < 0.00001), reduced bladder perforation (OR: 0.26, P < 0.00001), decreased bleeding (OR: 0.10, P < 0.0001), and improved detrusor muscle presence (OR: 3.22, P = 0.03). Overall complication rates were comparable (OR: 0.75, P = 0.28). TmL-ERBT significantly improved recurrence-free rates at 3 months (OR: 1.70, P = 0.02) and 12 months (OR: 1.45, P = 0.04), but no difference at 24 months (OR: 1.03, P = 0.82) and ≥ 30 months (OR: 0.85, P = 0.13) than TURBT. Subgroup analyses revealed the advantages of TmL-ERBT were most pronounced in low-risk, smaller, solitary tumors. TmL-ERBT demonstrated superior perioperative outcomes, enhanced safety with reduced complications compared with conventional TURBT. These findings supported TmL-ERBT as a promising alternative for NMIBC management.