Muscle-invasive bladder cancer (MIBC) in females frequently requires anterior pelvic exenteration (APE) for definitive management. The coexistence of a gastrointestinal malignancy such as an ileal neuroendocrine tumor (NET) further complicates the surgical approach, traditionally necessitating separate procedures. However, advances in robotic surgery have enabled safe, minimally invasive multiorgan resections. This case highlights a single-stage robotic APE combined with right hemicolectomy for simultaneous management of MIBC and a synchronous ileal NET, emphasizing feasibility, technical considerations, and outcomes.

A 42-year-old female with no comorbidities and a history of tubal ligation presented with a 3-year history of lower urinary tract symptoms (LUTS), and hematuria. Imaging and biopsy confirmed a muscle-invasive bladder tumor (pT2 high-grade) involving the right posterolateral wall with right external iliac lymph node metastases, along with a distal ileal NET (Grade 1, 19x14 mm, 5.7 cm from the ileocecal junction) and a left adnexal mass. After TURBT and six cycles of dose-dense MVAC chemotherapy, PET imaging showed residual disease. The patient underwent a single-stage robotic procedure using the Da Vinci Xi platform: APE including cystectomy, hysterectomy, bilateral salpingo-oophorectomy, anterior vaginal wall resection, and super-extended bilateral pelvic lymph node dissection with intracorporeal ileal conduit urinary diversion. A concurrent robotic right limited hemicolectomy with ileocolic anastomosis was performed for the ileal NET.

The total operative time was 7 hours with an estimated blood loss of 300 mL. No intraoperative complications occurred. The patient tolerated the procedure well, resumed oral intake by postoperative day 4, and was discharged on day 6. Final histopathology showed a pathological complete response in the bladder tumor (ypT0N0) and a Grade 2, moderately differentiated ileal NET (pT3N1M0).

Robotic multiorgan resection provides a safe and effective minimally invasive option for managing synchronous pelvic and gastrointestinal malignancies. A single-stage approach using robotic APE and right hemicolectomy minimized surgical burden, optimized recovery, and demonstrated favourable oncologic outcomes. This case underscores the potential role of robotic platforms in complex oncologic surgeries and supports further research into long-term outcomes and broader application.