Morbi-mortality of robot-assisted radical cystectomy for bladder carcinoma by urinary diversion type

To compare early and late complications rates after robot-assisted radical cystectomy for muscle invasive bladder tumors and certain high-risk non-muscle-invasive tumors according to the type of reconstruction. We conducted a single-center retrospective study including 109 patients who underwent robot-assisted radical cystectomy between 2008 and 2022. Patients were divided into two groups based on urinary diversion: extracorporeal Bricker ileal conduit (n = 74) or orthotopic neobladder (n = 35). Complications were graded by the Clavien-Dindo classification. Multivariate analysis identified independent risk factors for morbidity and mortality. Operative time was significantly longer for neobladder reconstruction (320 vs. 291 min, p = 0.047), as was hospital stay (14 vs. 10 days, p < 0.001). Early complications (< 30 days) occurred in 59.6% of patients, with a higher rate of minor complications in the neobladder group (57.1% vs. 28.4%, p = 0.006). There was no significant difference in major complications (Clavien III-V) or late complications (> 30 days), which affected 47.7% of patients. Operative time was an independent risk factor for major complications (OR = 1.15 per additional 15 min). Neobladder reconstruction was associated with increased early morbidity, mainly minor, without impact on late morbidity or mortality. Urinary diversion choice should be guided by patient profile and expected functional benefits.