Presentation Information
[E1-4]Robotic NOSES Combined with En Bloc Resection for Bilateral Lateral Lymph Node in Rectal Cancer
Yihang Shi, Zhixun Zhao, Xu Guan, Jinzhu Zhang, Jian Ma, Zheng Xu, Haipeng Chen, Xishan Wang (Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College)
Abstract
Background: Rectal cancer often metastasizes to bilateral lateral pelvic lymph nodes (LPLNs). While radical resection with lateral lymph node dissection (LLND) is standard for suspected metastasis, traditional piecemeal resection risks tumor dissemination. Natural orifice specimen extraction surgery (NOSES) enhances recovery by avoiding abdominal incisions. This first report combines robotic-assisted NOSES with en bloc resection for rectal cancer and bilateral LLND.
Methods: A 31-year-old male with mid-rectal adenocarcinoma and bilateral LPLN enlargement (8mm) underwent robotic en bloc tumor resection with bilateral LLND. Using a modified lithotomy position, retroperitoneal access was established at the left iliac bifurcation. Bilateral LLND and total mesorectal excision preserved specimen integrity. Transanal extraction followed intersphincteric resection, enabling direct anastomosis.
Results: Successful 391-minute procedure with 100mL blood loss. Bilateral internal/external iliac and obturator nodes were dissected without abdominal incisions/stomas. Discharge occurred on postoperative day 10. Pathology confirmed pT3N0M0 adenocarcinoma. Four-year follow-up showed no recurrence/metastasis, with preserved urinary/defecatory function.
Conclusion: Robotic NOSES with en bloc resection demonstrates safety and feasibility for locally advanced rectal cancer with bilateral LPLN metastasis. This technique combines oncologic radicality (minimizing tumor spread risk) and functional preservation, while transanal extraction optimizes recovery. The 4-year recurrence-free survival supports its dual benefits, offering a minimally invasive paradigm for complex cases. Multicenter validation and protocol standardization are warranted.
Background: Rectal cancer often metastasizes to bilateral lateral pelvic lymph nodes (LPLNs). While radical resection with lateral lymph node dissection (LLND) is standard for suspected metastasis, traditional piecemeal resection risks tumor dissemination. Natural orifice specimen extraction surgery (NOSES) enhances recovery by avoiding abdominal incisions. This first report combines robotic-assisted NOSES with en bloc resection for rectal cancer and bilateral LLND.
Methods: A 31-year-old male with mid-rectal adenocarcinoma and bilateral LPLN enlargement (8mm) underwent robotic en bloc tumor resection with bilateral LLND. Using a modified lithotomy position, retroperitoneal access was established at the left iliac bifurcation. Bilateral LLND and total mesorectal excision preserved specimen integrity. Transanal extraction followed intersphincteric resection, enabling direct anastomosis.
Results: Successful 391-minute procedure with 100mL blood loss. Bilateral internal/external iliac and obturator nodes were dissected without abdominal incisions/stomas. Discharge occurred on postoperative day 10. Pathology confirmed pT3N0M0 adenocarcinoma. Four-year follow-up showed no recurrence/metastasis, with preserved urinary/defecatory function.
Conclusion: Robotic NOSES with en bloc resection demonstrates safety and feasibility for locally advanced rectal cancer with bilateral LPLN metastasis. This technique combines oncologic radicality (minimizing tumor spread risk) and functional preservation, while transanal extraction optimizes recovery. The 4-year recurrence-free survival supports its dual benefits, offering a minimally invasive paradigm for complex cases. Multicenter validation and protocol standardization are warranted.