Kitaguchi Daichi, Enomoto Tsuyoshi, Furuya Kinji, Tsukamoto Shuntaro, Oda Tatsuya
Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1, Tennnodai, Tsukuba, Ibaraki, 305-8575, Japan.
Langenbecks Arch Surg. 2025 Jun 7;410(1):178. doi: 10.1007/s00423-025-03747-z.
The lateral pelvic cavity is an anatomically tricky site to access using a linear approach; therefore, robot-assisted lateral lymph node dissection (LLND) may be superior over existing laparoscopic procedures. In this study, we aimed to compare the short- and long-term outcomes of robot-assisted LLND (R-LLND) versus laparoscopic LLND (L-LLND) for locally advanced low rectal cancer and explore the potential advantages of robot-assisted surgery.
This single-center, retrospective cohort study included patients aged ≥ 18 years who underwent minimally invasive total mesorectal excision (TME) plus LLND for low rectal adenocarcinoma. Patients were divided into L-LLND and R-LLND groups. The short- and long-term outcomes of the procedures were compared.
There were 41 patients in the L-LLND group and 21 in the R-LLND group. The incidence of postoperative complications was significantly lower in the R-LLND group (49% vs. 19%, p = 0.029), especially urinary retention (29% vs. 5%, p = 0.046). The median postoperative hospital stay was significantly shorter in the R-LLND group (22 vs. 15 days, p < 0.001). The 3-year relapse-free survival rates in the L-LLND and R-LLND groups were 75.3% (95% confidence interval [CI]: 58.9-85.9) and 65.7% (95% CI: 30.7-86.1), respectively. No significant differences were observed in long-term survival outcomes.
Patients with locally advanced rectal cancer who underwent TME plus R-LLND had a significantly lower incidence of postoperative complications and a significantly shorter postoperative hospital stay compared to those who underwent TME plus L-LLND. The long-term outcomes were comparable, and no oncological concerns associated with R-LLND were observed.
盆腔外侧腔隙是一个解剖结构复杂、难以通过直线入路进行手术的部位；因此，机器人辅助下的侧方淋巴结清扫术（LLND）可能优于现有的腹腔镜手术。在本研究中，我们旨在比较机器人辅助LLND（R-LLND）与腹腔镜LLND（L-LLND）治疗局部进展期低位直肠癌的短期和长期疗效，并探讨机器人辅助手术的潜在优势。
本单中心回顾性队列研究纳入了年龄≥18岁、因低位直肠腺癌接受微创全直肠系膜切除术（TME）加LLND的患者。患者分为L-LLND组和R-LLND组。比较两组手术的短期和长期疗效。
L-LLND组有41例患者，R-LLND组有21例患者。R-LLND组术后并发症发生率显著较低（49% 对19%，p = 0.029），尤其是尿潴留（29% 对5%，p = 0.046）。R-LLND组术后中位住院时间显著更短（22天对15天，p < 0.001）。L-LLND组和R-LLND组的3年无复发生存率分别为75.3%（95%置信区间[CI]：58.9 - 85.9）和65.7%（95%CI：30.7 - 86.1）。长期生存结局未观察到显著差异。
与接受TME加L-LLND的患者相比，接受TME加R-LLND的局部进展期直肠癌患者术后并发症发生率显著更低，术后住院时间显著更短。长期疗效相当，未观察到与R-LLND相关的肿瘤学问题。
