Selective Lateral Pelvic Lymph Node Dissection: Comparative Study of Robot versus Laparoscopic Approach

Hye Jin Kim, Gyu-Seog Choi, Jun Seok Park, Soo Yeun Park, Hee Jae Lee. Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea

Background: Lateral pelvic lymph node dissection (LPND) is a challenging procedure due to its technical difficulty and higher incidence of surgical morbidity. The present study compared the short-term outcomes for laparoscopic versus robotic LPND in rectal cancer patients.

Methods: Between May 2006 and December 2014, prospectively collected data from consecutive patients who underwent robotic or laparoscopic total mesorectal excision (TME) with LPND were retrospectively compared. Data regarding patient demographics, perioperative outcomes, functional results, and initial oncologic outcomes were analyzed.

Results: Fifty and 35 patients underwent robotic or laparoscopic TME with LPND, respectively. Bilateral LPND was performed in 10 patients (20%) in the robotic group and 6 patients (17.1%) in the laparoscopic group. For unilateral pelvic dissection, the mean operative time did not show significant difference between groups (robot vs. laparoscopic group, 41.0 ± 15.8 vs. 35.3 ± 13.4 min; P = 0.146), but the estimated blood loss was significantly lower in the robotic group (34.6 ± 21.9 vs. 50.6 ± 23.8 mL; P = 0.002). Two patients (4.0%) in the robotic group and 7 patients (30.4%) in the laparoscopic group experienced Foley catheter reinsertion for their urinary retention, postoperatively (P = 0.029). The impairment of urinary function, analyzed by total IPSS after surgery, was lower in the robotic group. The mean number of harvested lateral pelvic lymph nodes was 6.6 (range, 0-25) in the robotic group and 6.4 (range, 1-14) in the laparoscopic group. During median follow-up of 26.3 months, 2 patient in the robotic group and 4 patients in the laparoscopic group experienced local recurrences.

Conclusions: Robotic TME with LPND was safe and feasible with favorable short-term surgical outcomes. Further large cohort studies and long-term follow-up are warranted.