Dissecção pélvica lateral em câncer retal avançado: revisão sobre técnicas robótica e laparoscópica

Abstract

Introduction: Advanced rectal cancer presents significant challenges due to the complex pelvic anatomy and high local recurrence rates. Lateral pelvic lymph node dissection (LPLND) combined with total mesorectal excision can reduce recurrences. Although laparoscopy minimizes complications, technical limitations persist; robotic surgery offers superior precision, higher lymph node yield, and lower morbidity, yet prospective evidence is still required.Objectives: To critically compare the efficacy, safety, and postoperative outcomes of lateral pelvic lymph node dissection in advanced rectal cancer, robotic versus laparoscopic.Methodology: This study was conducted as a narrative review, critically analyzing evidence on lateral pelvic lymph node dissection in advanced rectal cancer, comparing robotic and laparoscopic approaches between 2020 and 2025. Articles including adult patients, perioperative outcomes, and minimally invasive techniques were selected. The analysis identified advantages of robotic surgery in precision and number of lymph nodes retrieved, lower morbidity, and functional preservation, elucidating limitations and gaps in the literature.Results and Discussion: The narrative analysis showed that robotic lateral pelvic lymph node dissection (R-LPLND) presents perioperative advantages over laparoscopy, including lower morbidity, functional preservation, and higher lymph node yield, although total operative time is longer. Long-term outcomes suggest localized oncological benefits and higher overall survival; however, methodological limitations and study heterogeneity emphasize the need for prospective randomized trials for definitive validation.Conclusion: Robotic lateral pelvic lymph node dissection (R-LLND) in advanced rectal cancer demonstrated safety and functional benefits, including lower urinary retention and higher lymph node yield, yet prolonged operative time and study heterogeneity require prospective trials for validation.