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

Fabio  Rondelli; Alessio  Lucarini; Giovanni Maria  Garbarino; Graziano  Ceccarelli; Valentina  Tassi; Gioia  Brachini; Edoardo Maria  Muttillo; Leonardo  Di Cicco; Francesco Saverio  Li Causi; Alice  Ceccacci; Paolo  Mercantini; Gianluca  Costa

doi:10.62713/aic.3917

9 Jun 2025Systematic Review

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

Fabio Rondelli ^1,2Alessio Lucarini ³Giovanni Maria Garbarino ⁴Graziano Ceccarelli ²Valentina Tassi ⁵Gioia Brachini ⁶Edoardo Maria Muttillo ³Leonardo Di Cicco ³Francesco Saverio Li Causi ³Alice Ceccacci ³Paolo Mercantini ³Gianluca Costa ^7,8

Affiliations

Article Info

¹ Department of Surgical and Biomedical Sciences, School of Medicine, University of Perugia, 06100 Perugia, Italy

² Department of General Surgery, San Giovanni Battista Hospital, USL Umbria 2, 06034 Foligno, Perugia, Italy

³ Surgical and Medical Department of Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy

⁴ Upper Gastrointestinal Surgery Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy

⁵ Thoracic Surgery Unit, Santa Maria Hospital, 05100 Terni, Italy

⁶ Emergency Department, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy

⁷ Surgery Center, Colorectal Surgery Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, University Campus Bio-Medico of Rome, 00128 Rome, Italy

⁸ General Surgery, Department of Life Sciences, Health, and Health Professions, Link Campus University, 00165 Rome, Italy

Correspondence to: Alessio Lucarini, Surgical and Medical Department of Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy (e-mail: alessio.lucarini@uniroma1.it).

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

lateral lymph nodes
rectal cancer
colorectal surgery
robotic
lymphadenectomy