Ann Surg Treat Res.  2014 Feb;86(2):76-82. 10.4174/astr.2014.86.2.76.

Robotic and laparoscopic pelvic lymph node dissection for rectal cancer: short-term outcomes of 21 consecutive series

• Bae SU
• Saklani AP
• Hur H
• Min BS
• Baik SH
• Lee KY
• Kim NK

• KMID: 1908501
• DOI: http://doi.org/10.4174/astr.2014.86.2.76

Abstract

PURPOSE
The aim of this study is to describe our initial experience and assess the feasibility and safety of robotic and laparoscopic lateral pelvic node dissection (LPND) in advanced rectal cancer.
METHODS
Between November 2007 and November 2012, extended minimally invasive surgery for LPND was performed in 21 selected patients with advanced rectal cancer, including 11 patients who underwent robotic LPND and 10 who underwent laparoscopic LPND. Extended lymphadenectomy was performed when LPN metastasis was suspected on preoperative magnetic resonance imaging even after chemoradiation.
RESULTS
All 21 procedures were technically successful without the need for conversion to open surgery. The median operation time was 396 minutes (range, 170-581 minutes) and estimated blood loss was 200 mL (range, 50-700 mL). The median length of stay was 10 days (range, 5-24 days) and time to removal of the urinary catheter was 3 days (range, 1-21 days). The median total number of lymph nodes harvested was 24 (range, 8-43), and total number of lateral pelvic lymph nodes was 7 (range, 2-23). Six patients (28.6%) developed postoperative complications; three with an anastomotic leakages, two with ileus and one patient with chyle leakage. Two patients (9.5%) developed urinary incontinence. There was no mortality within 30 days. During a median follow-up of 14 months, two patients developed lung metastasis and there was no local recurrence.
CONCLUSION
Robotic and laparoscopic LPND is technically feasible and safe. Minimally invasive techniques for LPND in selected patients can be an acceptable alternative to an open LPND.

Keyword

Rectal neoplasms; Lymph node excision; Laparoscopy; Robotics

MeSH Terms

Anastomotic Leak
Chyle
Conversion to Open Surgery
Follow-Up Studies
Humans
Ileus
Laparoscopy
Length of Stay
Lung
Lymph Node Excision*
Lymph Nodes*
Magnetic Resonance Imaging
Mortality
Neoplasm Metastasis
Postoperative Complications
Rectal Neoplasms*
Recurrence
Robotics
Surgical Procedures, Minimally Invasive
Urinary Catheters
Urinary Incontinence

Figure

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  Fig. 1 Setup for the colonic phase in a robotic lateral pelvic node dissection for advanced rectal cancer.

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  Fig. 2 Setup for the pelvic phase in a robotic lateral pelvic node dissection for advanced rectal cancer.

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  Fig. 3 A Intraoperative views during a laparoscopic and robotic-assisted lateral pelvic node dissection. (A) Dissection of a lymph node around the external iliac vessels. (B) Dissection of a lymph node around the internal iliac artery. (C) Isolation of ureter with a silastic loop and dissection along the external iliac vessels. (D) Isolation of the obturator nerve and dissection of a lymph node in the obturator fossa.

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