Laparoscopic Cystectomy with Totally Intracorporeal Versus Extracorporeal Orthotopic Neobladder for Bladder Cancer: A Single Center Experience

Objective: The objective of this study was to compare the perioperative, oncological, and functional results and complications of extracorporeal orthotopic neobladder (EON) and totally intracorporeal orthotopic neobladder (ION) after laparoscopic radical cystectomy (LRC) in patients with muscle-invasive bladder cancer and high-risk nonmuscle-invasive bladder cancer. Methods: From January 2013 to October 2019, 152 patients underwent LRC and U-shape neobladder urinary diversion at a single tertiary referral hospital. We then compared the extracorporeal (n = 62) and intracorporeal (n = 90) orthotopic neobladder after laparoscopic cystectomy groups. Results: Of all patients, 90 with ION and 62 with EON were included in the study. Concerning perioperative outcomes, the ION group had lower estimated blood loss (455.7 versus 371.7 mL, P = .019), a shorter interval to solid food (6.9 versus 8.7 days, P = .006), and a shorter length of hospital stay (14.6 versus 16.0 days, P = .009). No statistically significant differences were identified in overall (P = .649), early (P = .509), and late (P = .367) complications. However, in terms of gastrointestinal complications, the ION group had a lower complication rate than the EON group (11.1% versus 27.4%, P = .018). There were no statistically significant differences in cancer-specific or noncancer-specific mortality. Daytime and nocturnal continence rates for the ION versus EON groups were 86.7% and 87.1% (P = 1) and 70.0% versus 66.1% (P = .614), respectively. Patients who underwent intracorporeal urinary diversion had a higher health-related quality of life within 3 months postoperative than the extracorporeal urinary diversion group. Conclusion: LRC with ION could be an alternative to EON with similar oncological and functional outcomes at tertiary referral centers. ION had advantages of faster bowel recovery, fewer gastrointestinal complications, and higher quality of life within 3 months postoperative. Clinical Trial Registration No. ChiCTR2100042063.