Robotic Versus Laparoscopic Lateral Lymph Node Dissection for Advanced Pelvic Cancers: a Systematic Review and Meta-analysis.

Abstract

Background: Lateral pelvic lymph node dissection (LPND) is a key component in the surgical treatment of advanced pelvic malignancies. Minimally invasive techniques have evolved over the past decade, with laparoscopic surgery as the traditional standard and robotic-assisted surgery emerging as a promising alternative. This study aimed to systematically compare robotic (R-LPND) and laparoscopic (L-LPND) approaches in terms of perioperative outcomes in patients undergoing LPND for advanced pelvic cancers.

Methods: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. The search was performed until April 1, 2024. The primary outcome was postoperative morbidity. Secondary outcomes included operative time, LPND-specific operative time, hospital stay duration, number of lymph nodes harvested, and rate of major complications.

Results: Eleven studies with 667 robotic and 568 laparoscopic cases were included. Robotic LPND was associated with significantly lower postoperative morbidity (OR 0.52; p = 0.02) and shorter hospital stays (MD - 2.30 days; p = 0.0003). However, robotic procedures had significantly longer operative times (MD 40.58 min; p = 0.003). No significant differences were observed in the number of lymph nodes harvested, LPND time, or rates of major complications. Heterogeneity was moderate to high for most outcomes, and the overall certainty of evidence ranged from low to moderate.

Conclusion: Robotic LPND may offer clinical benefits in terms of reduced morbidity and shorter hospitalization compared to laparoscopic surgery, although it is associated with longer operative time. These findings are based on evidence of low to moderate certainty and should be interpreted with caution due to the predominance of retrospective studies and notable inter-study heterogeneity.