Initial experience and results of robotic lateral pelvic lymph node dissection in locally advanced rectal cancer-a single center experience of 17 consecutive procedures.

Purpose: We have evaluated lateral pelvic lymph node dissection (LPLND) in combination with rectal resection in the treatment of locally advanced rectal cancer in a specialized colorectal surgical department with a focus on safety and feasibility.

Methods: The study analyzed surgical-pathologic outcomes in 17 consecutive patients who underwent robotic LPLND and rectal resection between May 2018 and June 2024 at a high-volume colorectal cancer center in Denmark. Patients were selected for the procedure based on lateral lymph node (LLN) diameter ≥ 8 mm before and ≥ 5 mm after neoadjuvant treatment.

Results: Out of 17 patients (15 men and 2 females) included in this study, 13 patients (76%) had undergone neoadjuvant therapy. The median age was 63 years (range 35-79) with a median BMI of 25.6 kg/m² (range 19.4-34.5). The total median operation time was 335 min (range 182-526 min) with no conversions necessary. Additional resection of structures beyond the total mesorectal excision plane was performed in eight patients (47%). The median hospital stay was 4 days (range 2-14) and one patient was readmitted within 30 days. Seven patients experienced postoperative complications within 30 days, with only one CD complication ≥ grade 3. The median number of resected LLNs was 4 (range 0-11) per patient and malignant LLNs were verified in three patients (17.6%).

Conclusion: This study shows that simultaneous robot-assisted LPLND and rectal resection can be performed safely and effectively in selected patients with locally advanced rectal cancer, with a short hospital stay and few readmissions and postoperative complications.