Abstract / Summary
Background: Radical cystectomy with pelvic lymph node dissection is the standard treatment for muscle-invasive bladder cancer and selected high-risk non-muscle invasive cases. While the conventional transperitoneal approach offers excellent exposure, extensive bowel manipulation may delay gastrointestinal recovery. The extraperitoneal approach aims to preserve peritoneal integrity, minimize bowel handling, and facilitate early recovery without compromising safety. Aims and Objectives: The aim of the study was to compare perioperative outcomes of extraperitoneal radical cystectomy (EPRC) versus transperitoneal radical cystectomy (TPRC) with ileal conduit diversion. Materials and Methods: A prospective comparative study was conducted over 30 months at R.G. Kar Medical College, Kolkata, following ethics approval (Memo No. RKC/1238). Forty consecutive patients were enrolled: 20 underwent EPRC and 20 TPRC. Outcomes included operative duration, transfusion, anesthetic requirement, recovery, drain output, hospital stay, surgical site infection, anastomotic leakage, and Clavien–Dindo complications. Follow-up included imaging and metabolic assessments for recurrence, strictures, and renal function. Results: Operative duration, transfusion, and anesthetic requirements were comparable (P>0.05). No intraoperative injury or anastomotic leakage occurred. EPRC patients resumed oral intake earlier (2.1±0.3 vs. 3.5±0.5 days; P<0.001) and had shorter hospital stay (7.3±0.8 vs. 9.6±0.9 days; P<0.001). Drain output, infection rates, and complication grades were similar. Conclusion: EPRC significantly enhances post-operative gastrointestinal recovery and shortens hospital stay while maintaining perioperative safety comparable to TPRC. Preservation of the peritoneum may complement ERAS protocols and optimize early recovery.