VA106 - Robotic salvage pelvic lymph node dissection for lateral recurrence in an operated case of low anterior resection

Purpose/Background: Lateral pelvic lymph node dissection in rectal cancer in technically demanding. It has a significant learning curve and is associated with a multitude of complications. Isolated lateral pelvic lymph node recurrences in a previously treated case of rectal adenocarcinoma is a unique surgical challenge. The tissue reaction to previous treatment makes this surgical procedure, even more complex.

While evidence regarding the robotic platform in rectal cancer has evolved, there is limited data regarding it's utilisation in this scenario. We wish to present our approach of lateral lymph node dissection in a female patient, previously treated for mid rectal cancer.

Methods/Interventions: Single case report of a 46 year old lady previously treated for mid rectal cancer (SCRT with nodal boost and 4 FOLFOX, followed by laparoscopic LAR and 8 cycles of adjuvant FOLFOX therapy). She presented with serial rise in CEA levels. MRI pelvis and PETCT showed an isolated recurrence in the right lateral nodal basin. She was then planned for robotic salvage right pelvic lymph node dissection. The DaVinci Xi platform was used for this procedure.

Results/Outcomes: The patient had an uneventful recovery and was discharged after 4 days. Histo-pathologicsl examination showed a deposit of adenocarcinoma in one node along with 3 reactive nodes. She is planned for adjuvant capecitabine.

Conclusion/Discussion: The robotic approach is safe for salvage lateral lymph node dissection when performed at high volume centres.

Robotic salvage PLND
Dissection along iliac bifurcation (obturator nerve identified and preserved)