Initial Results of D3 Lymphadenectomy in the Surgical Treatment of Cancer of the Right Half of the Segmented Intestine

Abstract

Introduction. Despite recent significant progress in chemotherapy treatment of primary non-metastatic cancer of the right half of the segmented intestine, surgery remains the primary method of treatment. Radical surgery includes removal of the tumour within the healthy tissues and regional lymph glands. Considering localisation of the primary tumour in the right half of the segmented intestine, hemicolectomy is typically performed on the right side. W. Hohenberger et al. have formulated a new concept of radical surgical treatment of the segmented intestine, consisting of the following components: complete mesocolic excision, early ligation of the lymphovascular pedicle and lymph dissection in the D3 volume.Purpose of the research: to analyse the early results of surgical treatment of cancer in the right half of the segmented intestine in the volume of the right-side hemicolectomy with D3 lymph node dissection depending on the method of surgical treatment.Materials and methods. At the premises of the Surgical Department No. 3 of the Republican Oncologic Dispensary (city of Ufa) a retrospective analysis of data of 59 patients was performed following right-side hemicolectomy using complete mesocolic excision, ligation lymphovascular pedicles and lymph node dissection in the D3 volume. Depending on the surgical access, all patients were divided into two main groups: group I (48 patients) — surgeries were performed using open method; group II (11 patients) — using laparoscopy.Results and discussion. Table 2 shows that the surgery performed with laparoscopy takes longer. However, statistically it results in significantly less blood loss. Patients who underwent open surgery were characterised by a longer stay in hospital. One of the effectiveness criteria is the number of removed lymph glands not differing for either group.Conclusion. Extended lymph dissection in the D3 volume for segmented intestine on the right side during cancer is a possible and safe method in case of laparoscopic and open procedures.

A global systematic review and meta-analysis on laparoscopic vs open right hemicolectomy with complete mesocolic excision

“…Among the examined studies, patients with stage IV disease were excluded, except for one [ 18 ]. The other studies include stages I, II and III, but two [ 14 , 25 ] only included stage III cancers and two [ 22 , 26 ] only included stages II and III; in addition, five studies [ 15 , 28 – 30 , 32 ] do not indicate the TNM stage.…”

“…Concerning tumour localisation, all of the studies considered cancers of cecum, ascending colon and hepatic flexure, while only five studies [ 17 , 20 , 22 , 31 , 32 ] also included proximal transverse colonic neoplasms.…”

“…There were one RCT, performed at Menoufia University (Egypt) [15,16] and 20 CCTs [14,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Sixteen studies were performed in Asia (4601 patients, 91.3%), including 13 from China (2158 patients), 2 from South Korea (2419 patients) and 1 from Bangladesh (24 patients).…”

“…Among the examined studies, patients with stage IV disease were excluded, except for one [18]. The other studies include stages I, II and III, but two [14,25] only included stage III cancers and two [22,26] Concerning tumour localisation, all of the studies considered cancers of cecum, ascending colon and hepatic flexure, while only five studies [17,20,22,31,32] also included proximal transverse colonic neoplasms.…”

“…Nine studies [16,19,21,22,24,27,[31][32][33] reported postoperative mortality at 30 days (n = 2471). No statistically significant difference was observed between the two groups (RR 0.53, 95% CI 0.13-2.11, P = 0.37, I 2 = 0%) (SDC 11).…”