A Case Report of Robotic Salvage Tumor Resection with Combined Resection of the Internal Iliac Vessels and Ureter for Lateral Local Recurrence after Lateral Lymph Node Dissection for Rectal Cancer.

INTRODUCTION: Lateral local recurrence (LLR) is a recognized pattern of local recurrence in patients with low rectal cancer (LRC) following curative resection, and salvage surgery for LLR is technically challenging. Recent studies have reported the feasibility of robotic lateral lymph node dissection (LLND) in patients with LRC; however, data regarding the safety and usefulness of robotic salvage surgery for LLR after LLND remain limited. Herein, we report a case of robotic salvage tumor resection with combined resection of the internal iliac vessels (IIVs) and ureter for LLR following LLND.

CASE PRESENTATION: A 65-year-old man underwent low anterior resection with LLND for LRC without preoperative treatment. The pathological diagnosis was pT3N1bM0, stage IIIB, and adjuvant chemotherapy was administered. LLR was detected 4 years after the initial surgery. Following preoperative long-course chemoradiotherapy (pre-CRT), the patient underwent robotic tumor resection with combined resection of the IIVs and ureter. Ureteroneocystostomy with psoas hitch was subsequently performed. The lumbosacral nerve trunk and sacral plexus were preserved. The operative time was 295 min, and the estimated blood loss was 40 mL. A negative resection margin was obtained. The patient remained recurrence-free at 6 months of follow-up.

CONCLUSIONS: This case demonstrates that robotic salvage surgery for LLR following LLND is feasible and can achieve oncologically adequate resection in a minimally invasive modality. The combination of the technical advantages of robotic surgery and tumor regression following pre-CRT may facilitate an optimal balance between oncological radicality and functional preservation.