Laparoscopic transperitoneal radical cystectomy/anterior pelvic exenteration is technically challenging, confined to centers with advanced laparoscopic expertise. We prospectively evaluated the surgical outcomes of laparoscopic transperitoneal radical cystectomy/anterior pelvic exenteration (LRC) with extracorporeal urinary diversion in patients with muscle-invasive carcinoma of the urinary bladder.

All consecutive patients with muscle-invasive carcinoma of the urinary bladder who underwent LRC by a single surgeon between January 2012 and May 2016 at our institution were included. Extracorporeal Urinary Diversion was performed as ileal conduit/orthotopic ileal neobladder (studer's technique) as per EAU guidelines. The demographic, peri-operative, postoperative and follow up data were collected and analyzed. The follow up was done as follows: every 3 months for the first 2 years, every 6 months for the next 3 years and then annually.

A total of 51 patients were included in the study. The mean age was 64.1 years. The male/female distribution was 39/12 respectively. The history of prior abdominal surgery and neo adjuvant chemotherapy was found in 25.5% and 7.8% of patients respectively. The extracorporeal ileal conduit and ileal neobladder (Studer) were done in 56.8% and 43.2% patients respectively. The mean operating time and mean estimated blood loss were 219 min and 357 ml respectively. There was no conversions to open surgery. Blood transfusion was required in 5 (9.8%) patients. The mean hospital stay and mean convalescence period were 6.1 days and 2.9 weeks respectively. Intra-operative and postoperative complications were seen in 4 (7.8%) and 7(11.7%) patients respectively. The histopathological stage pT2, pT3, pT4, pN0 and pN1-2 were found in 56.8%, 37.2%, 5.8%, 80.4%, and 19.6% of patients respectively. Positive surgical margins were found in 1(1.9%) patient. The mean number of lymph nodes was 17 (range: 9–21). Transitional cell carcinoma and adenocarcinoma were found in 94.1% and 5.9% of patients respectively. At mean follow up of 37.3 months, the local recurrence and distant metastases were found in 5.8% and 3.9% of patients respectively. The 3 year disease free and cancer specific survival were 88.2% and 90.1% respectively.

The laparoscopic transperitoneal radical cystectomy/anterior pelvic exenteration in patients with muscle-invasive carcinoma of the urinary bladder is technically feasible, safe with acceptable peri-operative morbidity, with excellent functional and oncological outcomes. However, this technically challenging procedure should only be attempted by surgeons of significant expertise.