Comparison of Laparoscopic and Robotic Lateral Lymph Node Dissection for Rectal Cancer: A Systematic Review and Meta-analysis of Short- and Long-term Outcomes

Abstract

Aim: The importance of lateral lymph node dissection (LLND) for advanced low rectal cancer is still questioned, but selected patients might benefit from this procedure. The purpose of this study was to compare robotic LLND (R-LLND) versus laparoscopic LLND (L-LLND) to identify the safety, feasibility, and advantages of R-LLND.

Methods: PubMed, Scopus, and Cochrane databases were searched for studies assessing the benefit of R-LLND over L-LLND. Pooled odds ratios (OR) and weighted mean difference (WMD) were obtained using models with random effects. The risk of bias was evaluated with the Newcastle-Ottawa scale.

Results: Six studies were included in our analysis for a total of 652 patients (316 robotic and 336 laparoscopic). The R-LLND group had a longer operative time (WMD 60.46, p = 0.02) and less blood loss (WMD -22.33, p = 0.01). Differences were found in the postoperative length of stays (7 days ± 1.2 and 14 ± 5.2 versus 7 days ± 0.3 and 16 ± 18.5, WMD -1.30, p = 0.03) and in the mean time to regular diet (3 days ± 0.5 and 5 ± 2.3 versus 3 days ± 1.2 and 6 ± 3.8, WMD -0.60 p = 0.01); a slightly higher number of harvested lateral lymph nodes was present in the L-LLND group (WMD 1.23, p = 0.02).

Conclusions: Our work demonstrates a slight benefit from the robotic approach when performing LLND in terms of intra- and peri-operative outcomes, despite not reaching statistical significance a trend in favor of robotic surgery is evident in almost all the analyzed topic.

Keywords: colorectal surgery; lateral lymph nodes; lymphadenectomy; rectal cancer; robotic.