Selective lateral pelvic lymph node dissection: a comparative study of the robotic versus laparoscopic approach

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Rectal Cancer Treatment

Background:

• Lateral pelvic lymph node dissection (LPND) is technically demanding, associated with significant surgical morbidity.
• Comparing robotic and laparoscopic approaches for LPND in rectal cancer is crucial for optimizing patient outcomes.

Purpose of the Study:

• To compare the short-term surgical outcomes of robotic versus laparoscopic lateral pelvic lymph node dissection (LPND) in patients with rectal cancer.
• To evaluate perioperative, functional, and oncologic results between the two surgical techniques.

Main Methods:

• Retrospective comparison of prospectively collected data from patients undergoing robotic or laparoscopic total mesorectal excision (TME) with LPND.
• Analysis included patient demographics, perioperative outcomes, functional results, and initial oncologic outcomes.

Main Results:

• Robotic LPND demonstrated significantly lower estimated blood loss (EBL) and fewer instances of postoperative urinary retention requiring Foley catheter reinsertion compared to laparoscopic LPND.
• Operative time, number of harvested lymph nodes, metastatic rate, and short-term recurrence rates were not significantly different between the robotic and laparoscopic groups.
• Specifically, EBL was 34.6 mL (robotic) vs. 50.6 mL (laparoscopic) (P=.002), and urinary retention occurred in 4.0% (robotic) vs. 20.0% (laparoscopic) (P=.029).

Conclusions:

• Robotic-assisted total mesorectal excision with lateral pelvic lymph node dissection (TME with LPND) is a safe and feasible surgical option.
• The robotic approach is associated with favorable short-term surgical outcomes, including reduced blood loss and lower rates of urinary complications.