LATERAL LYMPHADENECTOMY VIA ROBOTIC APPROACH IN COLORECTAL CANCER

MS, a 54-year-old female, sought proctological care due to intestinal constipation with ribbon-like stools and hematochezia that began two months earlier. Colonoscopy identified an infiltrative and ulcerated lesion approximately 4 cm from the anal margin, occupying 45% of the lumen. Subsequent histopathology confirmed a diagnosis of moderately differentiated adenocarcinoma. Pelvic MRI revealed a crescent-shaped infiltrative lesion in the anterior rectal wall, located 6 cm from the anorectal margin, showing signs of extension beyond the muscular layer, compromising the mesorectal fascia anteriorly to the left. Additionally, suspicious lymphadenopathy was identified in the external iliac and obturator chains on the left, measuring 2.1 cm, as well as in bilateral inguinal nodes. Neoadjuvant therapy with chemotherapy (capecitabine) and radiotherapy (5040/28) was initiated and completed in July 2022. A digital rectal exam performed post-neoadjuvant therapy showed a palpable lesion 4 cm from the anal margin, semicircumferential on the left lateral wall. A follow-up MRI performed 24 weeks post-treatment (February 2023) revealed the lesion now located 6.9 cm from the anal margin, infiltrating mesorectal fat at the 3 o'clock position with a radial extension of 6 mm, without evident signs of mesorectal fascia infiltration. The suspicious lymphadenopathies in the left iliac chain and bilateral inguinal regions persisted. ue to family reasons, the patient opted to delay surgical management, resuming follow-up at the end of 2023. A new MRI conducted 62 weeks after neoadjuvant therapy (November 2023) demonstrated progression of the lesion, now located 5 cm from the anal margin and 1.5 cm from the anorectal junction, with involvement of the left lateral mesorectal fascia and a suspicious lymph node in the left obturator chain. In December 2023, the patient underwent abdominoperineal amputation with robotic lateral lymphadenectomy. Histopathological analysis confirmed adenocarcinoma with vascular and perineural invasion and high tumor budding scores. Surgical margins were clear, but 13 lymph nodes in the main specimen were involved. The histopathology of the lateral lymphadenectomy revealed metastasis of adenocarcinoma in 3 lymph nodes. Currently, MS is undergoing adjuvant chemotherapy and remains under follow-up with the proctology team. This case includes an intraoperative video presentation of robotic lateral lymphadenectomy.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025