Robotic pelvic side‐wall dissection and en‐bloc excision for locally advanced and recurrent rectal cancer: outcomes on feasibility and safety

• Published in: ANZ journal of surgery Vol. 92; no. 9; pp. 2185 - 2191
• Main Authors: Lokuhetty, Naradha, Larach, José Tomás, Rajkomar, Amrish K. S., Mohan, Helen, Waters, Peadar S., Heriot, Alexander G., Warrier, Satish K.
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01-09-2022; Blackwell Publishing Ltd
• Subjects: Anastomotic leak; Antibiotics; Body mass; Body mass index; Body size; Cancer; Colorectal cancer; Complications; Demographic variables; Dissection; Feasibility; Intravenous administration; lateral pelvic lymph node dissection; Lymph nodes; Lymphatic system; Patients; pelvic sidewall; rectal cancer; Rectum; robotic; Robotics; Safety; Surgical anastomosis; lateral pelvic lymph node dissection; pelvic sidewall; robotic; rectal cancer
• DOI: 10.1111/ans.17757
• EISSN: 1445-2197
• ISSN: 1445-1433

Background
Global differences exist in managing lateral pelvic nodes in rectal cancer. Recent studies demonstrate improved local recurrence rates in patients undergoing lateral pelvic lymph node dissections (LPND) in addition to total mesorectal excision (TME) for advanced lower rectal cancer. This study aims to report on the safety and feasibility of the robotic approach in patients undergoing pelvic sidewall lymph node dissection or en‐bloc sidewall resection for advanced lower rectal cancer.
Methods
Patients who underwent an elective robotic pelvic sidewall lymph node dissection or en‐bloc sidewall resection for locally advanced rectal cancer with suspicious lateral lymph nodes or pelvic side wall involvement between January 2018 and March 2021 were included. Demographic, clinical, perioperative and histopathological variables were recorded and analysed.
Results
Eight patients (3 males) with a mean age of 55 (33–73) years and mean body mass index of 26.3 (20.7–30.0) kg/m2 were included. The median operative time and blood loss were 458.75 (360–540) min and 143.75 (100–300) mL, respectively. There were no conversions or intra‐operative complications. There were three post‐operative complications recorded (two ileus and one anastomotic leak which required an endoscopic washout in theatre and intravenous antibiotics thereafter). Median length of stay was 12.75 (7–23) days. All patients had an R0 resection, and the median lateral pelvic lymph node yield was 9.1 (6–14).
Conclusion
This series demonstrates the practicality and the safety of the robotic approach in the introduction of this technique for en‐bloc resection or LPND in patients with locally advanced rectal cancer.
Improved local recurrence rates have been identified in patients undergoing lateral pelvic lymph node dissections (LPND) in addition to total mesorectal excision for advanced lower rectal cancer. This series demonstrates the practicality and the safety of the robotic approach in the introduction of this technique for en‐bloc resection or LPND.