Comparison of perioperative and oncological outcomes between extracorporeal and intracorporeal urinary diversion following laparoscopic radical cystectomy and robot-assisted radical cystectomy

Background: This study aimed to compare oncological outcomes between intracorporeal urinary diversion (ICUD) and extracorporeal urinary diversion (ECUD) following radical cystectomy in Japan. Methods This retrospective study included 110 patients who underwent laparoscopic radical cystectomy (LRC) or robot-assisted radical cystectomy (RARC) from 2013 to 2023. Twenty-nine participants underwent LRC with ECUD, 40 participants underwent RARC with ECUD, and 32 participants underwent RARC with ICUD. Predictors of postoperative outcomes were evaluated using a Cox proportional hazards model. Recurrence-free survival (RFS) and overall survival (OS) were measured using the Kaplan-Meier method. Results Estimated RFS at 36 months for RARC with ICUD, RARC with ECUD and LRC with ECUD was 79.9% (95% CI 57.9–91.2), 52.5% (95% CI 31.1–70.1) and 62% (95% CI 40.7–77.5), respectively. Estimated OS at 36 months for RARC with ICUD, RARC with ECUD and LRC with ECUD was 87.1% (95% CI 54.4–96.9), 60.4% (95% CI 33.6–79.3) and 80.7% (95% CI 56.9–91.5), respectively. Conclusions There were no statistically significant differences in oncological outcomes between ECUD and ICUD based on surgical approach. Only pathological stage ≥ T3 and N positivity were common predictors of poor OS and RFS outcomes.