Selective lateral pelvic lymph node dissection: a comparative study of the robotic versus laparoscopic approach
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Lateral pelvic lymph node dissection (LPND) is a challenging procedure due to its technical difficulty and higher incidence of surgical morbidity. We compared short-term outcomes between laparoscopic and robotic LPND in patients with rectal cancer.
Between May 2006 and December 2014, prospectively collected data from consecutive patients undergoing robotic or laparoscopic total mesorectal excision (TME) with LPND were retrospectively compared. Patients’ demographics, perioperative outcomes, functional results, and initial oncologic outcomes were analyzed.
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 (17.1%) in the laparoscopic group. For unilateral pelvic dissection, the mean operative time was not significantly different between groups (robotic vs. laparoscopic group, 41.0 ± 15.8 min vs. 35.3 ± 13.4 min; P = 0.146), but the EBL was significantly lower in the robotic group (34.6 ± 21.9 mL vs. 50.6 ± 23.8 mL; P = 0.002). Two patients (4.0%) in the robotic group and 7 (20.0%) in the laparoscopic group underwent Foley catheter reinsertion for urinary retention postoperatively (P = 0.029). The mean number of harvested lateral pelvic lymph nodes (LPNs) was 6.6 (range 0–25) in the robotic group and 6.4 (range 1–14) in the laparoscopic group. Pathologic LPN metastatic rate was not different between groups (robotic vs. laparoscopic group, 28.0 vs. 41.2%; P = 0.243). During the median follow-up of 26.3 months, overall recurrence rate was not different between groups (robotic vs. laparoscopic group, 30.0 vs. 31.2%; P = 0.850). Three patients (6.0%) in the robotic group and 4 (11.4%) in the laparoscopic group developed local recurrence (P = 0.653).
Robotic TME with LPND is safe and feasible with favorable short-term surgical outcomes.
KeywordsRobotic surgery Lateral pelvic lymph node dissection Laparoscopic surgery
This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning (2016R1C1B2016002).
HJK—analysis and writing of the manuscript. G-SC—responsibility to correspondence and study proposal. JSP, SYP, HJL, ITW, and IKP—enrollment of patients, data collection, and study proposal.
Compliance with ethical standards
Dr. Hye Jin Kim, Gyu-Seog Choi, Jun Seok Park, Soo Yeun Park, Hee Jae Lee, In Taek Woo, and In Kyu Park have no conflicts of interest or financial ties to disclose.
Supplementary material 1 (WMV 207166 KB)
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