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Robotic versus laparoscopic approach for minimally invasive lateral pelvic lymph node dissection of advanced lower rectal cancer: a retrospective study comparing short-term outcomes

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Abstract

Purpose

The importance of lateral pelvic lymph node dissection (LLND) for advanced low rectal cancer is gradually being recognized in Europe and the USA, where some patients were affected by uncontrolled lateral pelvic lymph node (LLNs) metastasis, even after total mesorectal excision (TME) with neoadjuvant chemoradiotherapy (CRT). The purpose of this study was thus to compare robotic LLND (R-LLND) with laparoscopic (L-LLND) to clarify the safety and advantages of R-LLND.

Methods

Sixty patients were included in this single-institution retrospective study between January 2013 and July 2022. We compared the short-term outcomes of 27 patients who underwent R-LLND and 33 patients who underwent L-LLND.

Results

En bloc LLND was performed in significantly more patients in the R-LLND than in the L-LLND group (48.1% vs. 15.2%; p = 0.006). The numbers of LLNs on the distal side of the internal iliac region (LN 263D) harvested were significantly higher in the R-LLND than in the L-LLND group (2 [0–9] vs. 1 [0–6]; p = 0.023). The total operative time was significantly longer in the R-LLND than in the L-LLND group (587 [460–876] vs. 544 [398–859]; p = 0.003); however, the LLND time was not significantly different between groups (p = 0.718). Postoperative complications were not significantly different between the two groups.

Conclusion

The present study clarified the safety and technical feasibility of R-LLND with respect to L-LLND. Our findings suggest that the robotic approach offers a key advantage, allowing significantly more LLNs to be harvested from the distal side of the internal iliac region (LN 263D). Prospective clinical trials examining the oncological superiority of R-LLND are thus necessary in the near future.

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Data Availability

All data were obtained from medical records.

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Acknowledgements

We would like to thank Editage (https://www.editage.jp) for English language editing.

Funding

This study has not received specific funding from any funding agency, public, for-profit or non-profit.

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Authors and Affiliations

  1. Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan

    Tetsuo Ishizaki, Junichi Mazaki, Kenta Kasahara, Ryutaro Udo, Tomoya Tago & Yuichi Nagakawa

Authors
  1. Tetsuo Ishizaki
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  2. Junichi Mazaki
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  3. Kenta Kasahara
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  4. Ryutaro Udo
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  5. Tomoya Tago
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  6. Yuichi Nagakawa
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Contributions

Study conception and design: TI; Data acquisition: TI, JM; Data interpretation: TI, RU, TT, KK; Drafting the manuscript: TI; Supervision of the manuscript: YN.

Corresponding author

Correspondence to Tetsuo Ishizaki.

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Ishizaki, T., Mazaki, J., Kasahara, K. et al. Robotic versus laparoscopic approach for minimally invasive lateral pelvic lymph node dissection of advanced lower rectal cancer: a retrospective study comparing short-term outcomes. Tech Coloproctol 27, 579–587 (2023). https://doi.org/10.1007/s10151-023-02818-x

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