{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T12:03:48Z","timestamp":1780056228567,"version":"3.54.0"},"reference-count":19,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2023,11,30]],"date-time":"2023-11-30T00:00:00Z","timestamp":1701302400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>One of the most complex surgeries including radical cystectomy (RC) has a high rate of morbidity. The standard approach for the muscle-invasive bladder is conventional transperitoneal radical cystectomy. However, the procedure is associated with significant morbidities like ileus, urinary leak, bleeding, and infection. The aim of this study is to compare the transperitoneal RC approach with the extraperitoneal RC approach in the treatment of bladder cancer patients. The outcomes of this study are Operative time, Estimated Blood Loss, Hospital Stay, Post-Operative Ileus, Infection, and Major Complication (Clavien-Dindo Grade 3\u20135).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>PubMed, Cochrane Library, and Science Direct were systematically searched for different publications related to the meta-analysis. Keywords used for searching were Radical Cystectomy AND Extraperitoneal AND Transperitoneal up until 31<jats:sup>st<\/jats:sup> August 2022. The studies were screened for our eligibility criteria. Demographic parameters, perioperative variables, and postoperative complications were recorded and analyzed. The Newcastle-Ottawa Scale was used to evaluate the risk of bias in each study. The Review Manager (RevMan) software version 5.4.1 was used for statistical analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Eight studies (3 laparoscopic and 5 open methods) involving 1207 subjects (588 patients using the extraperitoneal approach and 619 using the transperitoneal approach) were included. The incidence of postoperative ileus is significantly lower after the extraperitoneal approach compared to the transperitoneal approach (p &lt; 0.00001). The two techniques did not differ in operative time, estimated blood loss, duration of hospital stay, total infection, and major complication events.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>This meta-analysis shows that extraperitoneal radical cystectomy benefits in terms of reduced postoperative ileus.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0294809","type":"journal-article","created":{"date-parts":[[2023,11,30]],"date-time":"2023-11-30T18:42:11Z","timestamp":1701369731000},"page":"e0294809","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Transperitoneal vs extraperitoneal radical cystectomy: A systematic review and meta-analysis"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2186-4049","authenticated-orcid":true,"given":"Kevin","family":"Leonardo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendy","family":"Mirza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doddy Hami","family":"Seno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nugroho","family":"Purnomo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andika","family":"Afriansyah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0382-9522","authenticated-orcid":true,"given":"Moammar Andar Roemare","family":"Siregar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,11,30]]},"reference":[{"issue":"4","key":"pone.0294809.ref001","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/j.euf.2019.09.003","article-title":"What is the significance of variant histology in urothelial carcinoma?","volume":"6","author":"N Lobo","year":"2020","journal-title":"Eur Urol Focus."},{"issue":"1","key":"pone.0294809.ref002","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.eururo.2020.03.055","article-title":"European Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2020 Guidelines.","volume":"79","author":"JA Witjes","year":"2021","journal-title":"Eur Urol."},{"issue":"1","key":"pone.0294809.ref003","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1186\/s12957-022-02587-1","article-title":"Extraperitoneal laparoscopic radical cystectomy with intracorporeal neobladder: a comparison with transperitoneal approach.","volume":"20","author":"Y Zhang","year":"2022","journal-title":"World J Surg Oncol."},{"issue":"11","key":"pone.0294809.ref004","doi-asserted-by":"crossref","first-page":"1711","DOI":"10.1007\/s00345-018-2313-8","article-title":"Perioperative outcomes and complications of intracorporeal vs extracorporeal urinary diversion after robot-assisted radical cystectomy for bladder cancer: a real-life, multiinstitutional french study","volume":"36","author":"L Lenfant","year":"2018","journal-title":"World J Urol"},{"issue":"2","key":"pone.0294809.ref005","doi-asserted-by":"crossref","first-page":"187","DOI":"10.3233\/BLC-200280","article-title":"Extraperitoneal Antegrade Vs Transperitoneal Open Radical Cystectomy: Single Center Experiences with 200","volume":"6","author":"Orkunt \u00d6zkaptan","year":"2020","journal-title":"Cases. Bladder Cancer"},{"key":"pone.0294809.ref006","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.eururo.2010.10.030","article-title":"Readaptation of the peritoneum following extended pelvic lymphadenectomy and cystectomy has a significant beneficial impact on early postoperative recovery and complications: results of a prospective randomized trial.","volume":"59","author":"B Roth","year":"2011","journal-title":"Eur Urol."},{"key":"pone.0294809.ref007","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1046\/j.1442-2042.2003.00560.x","article-title":"Antegrade extraperitoneal approach to radical cystectomy and ileal neobladder","volume":"10","author":"TA Serel","year":"2003","journal-title":"Int J Urol"},{"issue":"2","key":"pone.0294809.ref008","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1590\/s1677-5538.ibju.2017.0441","article-title":"Transperitoneal vs. extraperitoneal radical cystectomy for bladder cancer: A retrospective study","volume":"44","author":"JN Kulkarni","year":"2018","journal-title":"Int Braz J Urol"},{"issue":"4","key":"pone.0294809.ref009","doi-asserted-by":"crossref","first-page":"e271","DOI":"10.1016\/j.clgc.2015.01.006","article-title":"Laparoscopic Radical Cystectomy Versus Extraperitoneal Radical Cystectomy: Is the Extraperitoneal Technique Rewarding","volume":"13","author":"J Zhao","year":"2015","journal-title":"Clin Genitourin Cancer"},{"key":"pone.0294809.ref010","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1016\/j.urology.2010.06.042","article-title":"Chewing gum has a stimulatory effect on bowel motility in patients after open or robotic radical cystectomy for bladder cancer: a prospective randomized comparative study","volume":"77","author":"H Choi","year":"2011","journal-title":"Urology"},{"issue":"2","key":"pone.0294809.ref011","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"D Dindo","year":"2004","journal-title":"Ann Surg"},{"issue":"5","key":"pone.0294809.ref012","first-page":"519","article-title":"Extra-Peritoneal versus Trans-Peritoneal Open Radical Cystectomy\u2014Comparison of Two Techniques in Early Post-Operative Complications.","volume":"18","author":"M Soleimani","year":"2021","journal-title":"Urol J."},{"issue":"4","key":"pone.0294809.ref013","first-page":"457","volume":"28","author":"F Jentzmik","year":"2010","journal-title":"Extraperitoneal radical cystectomy with extraperitonealization of the ileal neobladder: a comparison to the transperitoneal technique.World J Urol"},{"issue":"4","key":"pone.0294809.ref014","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.51253\/pafmj.v71i4.4136","article-title":"Comparison of Extraperitoneal and Transperitoneal Radical Cystoprostatectomy in Terms of First 30 Days Outcome.","volume":"71","author":"M. Sajjad","year":"2021","journal-title":"Pak Armed Forces Med J"},{"key":"pone.0294809.ref015","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1097\/SLE.0b013e318172fca2","article-title":"A strangulated internal hernia behind the external iliac artery after a laparoscopic pelvic lymphadenectomy","volume":"18","author":"KM Kim","year":"2008","journal-title":"Surg Laparosc Endosc Percutan Tech"},{"issue":"6","key":"pone.0294809.ref016","article-title":"A Comparative Study between Antegrade (Transperitoneal) and Retrograde (Extraperitoneal) Radical Cystectomy Regarding Recovery of Bowel Function","volume":"7","author":"O. Zaytoun","year":"2019","journal-title":"Journal Of Medical Science And Clinical Research"},{"issue":"1","key":"pone.0294809.ref017","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1093\/ejcts\/ezv453","article-title":"Factors influencing length of stay after surgery for benign foregut disease","volume":"50","author":"KJ Dickinson","year":"2016","journal-title":"Eur J Cardiothorac Surg"},{"issue":"4","key":"pone.0294809.ref018","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1590\/S1677-5538.IBJU.2015.0608","article-title":"Extraperitoneal versus transperitoneal laparoscopic radical cystectomy for selected elderly bladder cancer patients: a single center experience.","volume":"42","author":"L Feng","year":"2016","journal-title":"Int Braz J Urol"},{"issue":"3","key":"pone.0294809.ref019","first-page":"4794","article-title":"Comparative Characteristics of the Direct Results of Extraperitoneal and Transperitoneal Access in the Surgical Treatment of Bladder Cancer","volume":"25","author":"T. Mirzagleb","year":"2021","journal-title":"Annals of R.S.C.B"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0294809","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,30]],"date-time":"2023-11-30T18:42:32Z","timestamp":1701369752000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0294809"}},"subtitle":[],"editor":[{"given":"Atalel Fentahun","family":"Awedew","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,11,30]]},"references-count":19,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11,30]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0294809","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,30]]}}}