The current study may be the first prospective study that focused on the comparison of the effect of clinical stage of BC on the outcome of LRC.
The outcome of LRC in the current study was similar to what previously was reported in a systematic review on LRC . In that meta-analysis, Tang et al. compared LRC versus ORC and analyzed sixteen studies (seven prospective and nine retrospective studies) with 1165 cases (545 LRC and 620 ORC). The LRC group had a lower ASA score and a significantly higher proportion of organ confined ≤ pT2 disease and fewer nodal disease (11%) which lead to lower distant metastasis rate (8.6%) and fewer death (8.4%). However, there was no significant difference in other criteria including age, gender, BMI, history of previous surgery, pathological grade and type of diversion . We had a higher incidence of nodal disease (27.7%), but we had no mortalities which may be due to exclusion of T4 cases and short follow-up in the current study. In their meta-analysis, Tang et al. reported that there were no differences between the LRC and ORC in wound dehiscence, neurologic, renal fistula/leak, ureteric obstruction, GI fistula/leak or thromboembolic events. However, LRC had a longer operative time (371.5 min) but significantly fewer overall complications (33.5%) including less blood loss (469.15 mL), less infections especially wound infections, shorter time to ambulation and shorter length of hospital stay (15.3 days), less need of blood transfusion (25.7%), less narcotic analgesic requirement, less ileus (11%) and fewer positive surgical margins (3%) . We had a comparable complications rates (29.78%), ileus (10.6%), blood loss (458.9 mL) and blood transfusion (17%). Furthermore, we had a comparable operative time (316.9 min).
In a more recent study, Khan et al.  compared the outcomes of ORC, RARC, and LRC in 60 patients. Similar to our study, the urinary diversion was performed extracorporeally. ORC complication rate (70%) was significantly higher than LRC (26%) but no significant difference in major complications . In the LRC arm (19 patients), the mean operative time (301 min), mean EBL (460 mL) and mean hospital stay (9.7 days) were similar to our results.
In the current study, the clinical stage did not affect the operative and postoperative outcome including operative time, EBL and blood transfusion, complications, return to bowel activity, ICU stay and hospital stay. Moreover, we repeated the analysis according to pathological stage without detecting any significant difference in these parameters between pT2 group and pT3 group. Only postoperative pain on day 1 was less in pT2 group. We found only one study that commented on the tumor stage as a predictor of postoperative complications after LRC . It was a retrospective multicenter study that assessed risk factors for postoperative complications in 548 patients. In that study, urinary diversion was performed mainly via an extracorporeal approach (95%). As regards the pathological stage, 56% of patients had organ-confined disease (pT ≤ 2) and 44% had locally advanced disease (pT3–4), while 24% had positive nodes. In that study, Albisinni et al. reported a median hospital stay of 14 days and a positive surgical margin rate of 5.8%. Conversion to an open approach occurred in 12 patients (2%), mainly as a consequence of extensive intraabdominal adherences (0.91%) or due to massive bleeding (1.09%). Albisinni et al. reported also a 29% minor complications (Clavien 1–2), while 18% experienced major complications (Clavien ≥ 3). A total of 12% of patients underwent surgical reoperation. Most reoperations were due to bowel leaks, urinary leaks or wound dehiscence . In the current study, we had a similar rate of minor complications but less major complications and also less rate of reoperation (6.38%) which may be due to exclusion of T4 cases. In their retrospective multicenter study, Albisinni et al.  reported that increased BMI, blood loss and neoadjuvant treatment were significantly associated with a greater risk of complications. They reported also that a pT status was not a significant predictor of overall complication risk similar to our results.
Although this study will add data to the literature data regarding effect of the clinical and pathological stages on the outcome of LRC, it has its limitations. The number of patients was adequate according to the sample size but more studies with larger number of patients are important for a better analysis of complications and subgroups. Additionally, the study has short-term follow-up. However, it was reasonable for the primary outcome intended in this study.