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Robot-assisted lateral pelvic lymph node dissection in patients with advanced rectal cancer: a single-center experience of 65 cases

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Abstract

The treatment of lateral pelvic lymph node (LPLN) metastasis of rectal cancer has evolved because of technical difficulties from open surgery to laparoscopy and, recently, robot-assisted surgery. This study aimed to evaluate the technical feasibility and short- and long-term outcomes of robot-assisted LPLN dissection (LPND) following total mesorectal excision (TME) in advanced rectal cancer. Clinical data of 65 patients who underwent robotic-assisted TME with LPND from April 2014 to July 2022 were reviewed. Data regarding operative details, postoperative morbidity (within 90 postoperative days) for short-term outcomes and lateral recurrence as long-term outcomes were analyzed. Among the 65 patients with LPND, preoperative chemoradiotherapy was performed in 49 (75.4%). The mean operative time was 306.8 (range 191–477) min, and the mean time of unilateral LPND was 38.6 (range 16–66) min. LPND was bilaterally performed in 19 (29.2%) patients. The mean number of each side of harvested LPLNs was 6.8. Lymph node metastasis was observed in 15 (23.0%) patients, and 10 (15.4%) patients had postoperative complications. Lymphocele (n = 3) and pelvic abscess (n = 3) were the most common, followed by voiding difficulty, erectile dysfunction, obturator neuropathy, and sciatic neuropathy (all n = 1). During the 25 months of median follow-up, no lateral recurrence of the LPND site was noted. Robot-assisted LPND following TME is safe and feasible and showed acceptable short- and long-term outcomes. Despite some study limitations, we may be able to apply this strategy more widely through subsequent prospective controlled studies.

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Data availability statement

The dataset are available from corresponding author, Yong Sik Yoon, upon reasonable request.

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea

    Eon Bin Kim, Yong Sik Yoon, Min Hyun Kim, Young Il Kim, Jong Lyul Lee, Chan Wook Kim, In Ja Park, Seok-Byung Lim, Chang Sik Yu & ** Cheon Kim

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  1. Eon Bin Kim
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  2. Yong Sik Yoon
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  3. Min Hyun Kim
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  4. Young Il Kim
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  7. In Ja Park
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  8. Seok-Byung Lim
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Contributions

All authors contributed to the study design and analysis. Material preparation was performed by Eon Bin Kim, Yong Sik Yoon, In Ja Park, ** Cheon Kim. Data collection, analysis and the first draft of the manuscript was written by Eon Bin Kim and all authors revised critically and commented on the previous version of the manuscript. All authors participated and approved the final manuscript.

Corresponding author

Correspondence to Yong Sik Yoon.

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Conflict of interest

The authors declare no competing interests.

Ethical approval

The study protocol was approved by the Institutional Review Board in accordance with the 1964 Helsinki Declaration. The study protocol was approved by institutional review board of Asan Medical Center (Date 18 Sep 2022/IRB no. 2022–1264).

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The review board waived the requirements for informed consent, as this study was a retrospective analysis.

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Kim, E.B., Yoon, Y.S., Kim, M.H. et al. Robot-assisted lateral pelvic lymph node dissection in patients with advanced rectal cancer: a single-center experience of 65 cases. J Robotic Surg 17, 1697–1703 (2023). https://doi.org/10.1007/s11701-023-01570-6

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