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. 2025 Jun 6:15:1592406.
doi: 10.3389/fonc.2025.1592406. eCollection 2025.

Clinical efficacy of laparoscopic radical cystectomy with intracorporeal urinary diversion and an analysis of factors influencing complications

Hongzhi Fang #  1 , Huihua Ji #  1 , Changjian Shi  1 , Benrui Zhou  1 , Jie Xu  1 , Yuli Luo  1 , Yunfei Li  1
Affiliations

Clinical efficacy of laparoscopic radical cystectomy with intracorporeal urinary diversion and an analysis of factors influencing complications

Hongzhi Fang et al. Front Oncol. .

Abstract

Purpose: To explore the feasibility of combined laparoscopic radical cystectomy (LRC) and intracorporeal urinary diversion (ICUD) in the treatment of bladder cancer, as well as the influencing factors related to complications.

Methods: A retrospective study was conducted on 116 bladder cancer patients who underwent LRC at our facility between January 2019 and December 2023. Based on the different urinary diversion methods, 78 patients received extracorporeal urinary diversion (ECUD), while 38 patients underwent intracorporeal urinary diversion (ICUD). The two groups were compared in terms of clinicopathologic data, perioperative outcomes, postoperative tumor control, complication rates, and their influencing factors.

Results: No statistically significant differences were observed between the two groups in terms of median total operative time, hospital stay, perioperative transfusion rate, and short-term oncological outcomes. Compared to the ECUD group, the ICUD group experienced less intraoperative blood loss (200 ml vs. 350 ml) and an earlier start to postoperative liquid diet intake (4 days vs. 5 days) (p < 0.05). A total of 24 cases of ≥III grade complications occurred within 90 days postoperatively, with 20 cases in the ECUD group and 4 in the ICUD group. There was no significant difference in the incidence of ≥III grade complications between the two groups (p > 0.05). Sepsis was the most common major complication. Logistic regression analysis identified smoking history, diabetes, and intraoperative blood loss as independent risk factors for ≥III complications.

Conclusions: ICUD is a secure and effective method with advantages such as improved postoperative bowel recovery, reduced intraoperative blood loss, and fewer overall postoperative complications. Furthermore, major complications are influenced by multiple risk factors and should be carefully considered during preoperative and postoperative management.

Keywords: bladder cancer; complications; laparoscopy; risk factors; urinary diversion.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The key operational procedures of orthotopic neobladder construction intracorporeal. (A) Left ureteral retroperitoneal tunnel; (B) Anterior rectus fascia fixation of the intestine; (C) Intestinal-urethral anastomosis; (D) Longitudinal intestinal anastomosis; (E) Intestinal anastomosis; (F) Bowel detubularization; (G) Posterior wall anastomosis of the neobladder; (H) Anterior wall anterior half anastomosis of the neobladder; (I) Ureteral Wallance anastomosis; (J) Intestinal-ureteral anastomosis; (K) Anterior wall anastomosis of the neobladder; (L) Neobladder leakage test.
Figure 2
Figure 2
Comparison of PFS and OS in LRC with ECUD and ICUD. ECUD, Extracorporeal urinary diversion; ICUD, Intracorporeal urinary diversion; PFS, Progression-free survival; OS, Overall survival; LRC, Laparoscopic radical cystectomy.
Figure 3
Figure 3
Clavien-Dindo classification of total complications (I-V) and major complications (III-V).
See this image and copyright information in PMC

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