Laparoscopic Versus Robotic Lateral Pelvic Lymph Node Dissection in Locally‐Advanced Rectal Cancer: A Cohort Study Comparing Perioperative Morbidity and Short‐Term Oncological Outcomes

Abstract

ABSTRACT Background Robotic surgery has been associated with superior short‐term outcomes in patients undergoing total mesorectal excision (TME) for organ‐confined rectal cancer. However, whether this approach offers an additional benefit over laparoscopy when performing lateral pelvic lymph node dissection (LPLND) with TME or extended TME (e‐TME) in locally advanced rectal cancer (LARC) is not known. Aims This study was conducted to evaluate the outcomes of robotic and laparoscopic LPLND in patients with lateral pelvic node‐positive LARC with reference to intraoperative safety, postoperative morbidity, pathological indices including nodal yield and node positivity rates, lateral pelvic recurrence rates, and short term event‐free and overall survival. Methods and Results In this retrospective single‐center study, consecutive patients with non‐metastatic histologically proven LARC and clinically significant lateral pelvic lymphadenopathy who had undergone laparoscopic or robotic LPLND with TME or e‐TME between 2014 and 2023 were included, all procedures having been performed by minimal‐access colorectal surgeons who were beyond the learning curve for either surgical approach. Of the 115 patients evaluated, 98.3% received neoadjuvant chemoradiotherapy, following which 27 (23.5%) underwent robotic and 88 (76.5%) laparoscopic LPLND with TME or e‐TME. The baseline clinicodemographic features, treatment‐related characteristics, and proportion of patients undergoing extended resections for persistent circumferential resection margin‐positive rectal cancer (22.7% vs. 18.5%, respectively) were statistically similar in both groups. When comparing robotic with laparoscopic resections, no significant difference was observed in intraoperative parameters including procedure‐associated blood loss (median 250 mL vs. 400 mL) and on‐table adverse events or conversion rates (none in either group), postoperative outcomes comprising clinically significant early (14.8% vs. 9.1%), intermediate (5.3% vs. 1.9%) and late (5.3% vs. 2.0%) surgical morbidity, re‐exploration rates (7.4% vs. 3.4%) and duration of hospital stay (median 6 days in both groups), or the pathological quality indices of margin involvement (7.4% vs. 2.3%), nodal yield (median 4 vs. 7 nodes) and lateral node positivity (22.2% vs. 26.1%), respectively. At a median 11 months follow‐up, oncological outcomes in terms of lateral pelvic recurrence rates (3.7% vs. 4.5%), 2‐year event‐free survival (78.7% vs. 79.3%) and 2‐year overall survival (83.1% vs. 93.8%) were also comparable. Conclusion Surgical competence in laparoscopy may offset the potential benefits extended by robotic platforms. In a high‐volume setup with experienced minimal‐access surgeons, the clinical, pathological, and short‐term oncological outcomes associated with both approaches may be considered equivalent.

Keywords

• cancer management
• clinical cancer research
• clinical outcome
• colorectal cancer
• surgical oncology
• surgical therapy