Long-term oncologic outcome of D3 lymph node dissection for clinical stage 2/3 right-sided colon cancer

Yoon, Sunseok; Ji, Woong Bae; Kim, Jung-Sik; Hong, Kwang Dae; Um, Jun Won; Min, Byung Wook; Lee, Sun-Il; Kang, Seongwon; Ju, Yeonuk; Kim, Jin; Kwak, Jungwon; Baek, Se Jin

doi:10.1007/s00384-023-04310-2

Cited by 6 publications

(3 citation statements)

References 31 publications

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“…В ретроспективном исследовании S. Yoon et al [24] была проведена оценка отдаленных результатов лечения 295 больных РППОК II-III стадий. При этом авторам удалось получить статистически значимые различия в показателях пятилетней безрецидивной выживаемости при выполнении правосторонней гемиколэктомии с D3-лимфодиссекцией -90,2 и в группе с D2-лимфодиссекцией -80,5 % (p = 0,028).…”

Section: Discussionunclassified

Comparative Analysis of the Outcomes of Laparoscopic Right Hemicolectomy with D2 and D3 Lymphadenectomy in the Treatment of Patients with Right Colon Cancer

Nevolskikh,

Avdeenko,

Mikhaleva

et al. 2024

Rossijskij žurnal gastroènterologii, gepatologii, koloproktolog

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Introduction. The standard volume of removed groups of lymph nodes for right colon cancer (RCC) has not been determined. According to Japanese clinical guidelines, it is necessary to perform D3 lymphadenectomy in all cases, except stage I, while according to European and Russian clinical guidelines, the standard scope of surgical intervention includes only D2 lymphadenectomy. There are no long-term results regarding differences between D2 and D3 lymph node dissection in RCC; therefore, it is relevant to conduct studies to improve the long-term results of treatment of patients with RCC.Aim: to comparatively evaluate the results of treatment of patients with RCC who underwent laparoscopic right hemicolectomy at A. Tsyb Medical Radiological Research Center.Materials and methods. Conducted from 2018 to 2023, the study included 174 patients with stage I–III RCC: in 106 patients, laparoscopic right hemicolectomy with D2 lymph node dissection was performed, in 68 patients — with D3 lymph node dissection. When assessing the homogeneity and comparability of the groups, according to input parameters, such as clinical stage, gender, age, body mass index and tumor location, their heterogeneity was noted, which did not allow a direct comparative assessment of both groups. To eliminate heterogeneity and adequately select groups, a pseudorandomization technique was used, after which the groups (n = 68) became statistically comparable in all main clinical parameters.Results. Statistically significant differences were obtained in the median duration of surgical intervention, which was longer in the group of patients with D3 lymph node dissection — 150 (60–393) and 213 (70–390) minutes (p < 0.001), and in the median time of flatus passage — 2 (1–4) and 3 (1–9) days, respectively (p = 0.042). Postoperative complications in accordance with the Clavien — Dindo classification occurred in 16 (23.5 %) patients in the group with D2 and in 15 patients (22.1 %) in the group with D3 lymph node dissection (p = 0.999); III–V grade complications were noted in 2 (2.9 %) cases in each group (p = 0.999). Postoperative hospital stay was 6 days for patients in both groups (p = 0.369). During pathomorphological assessment of the removed specimen, the median number of examined lymph nodes was significantly higher in the group with D3 lymph node dissection: 14 (1–52) and 19 (3–59) lymph nodes, respectively (p < 0.001). Involvement of apical lymph nodes (groups 203, 213, 223) was noted in 2 (3 %) patients. In the group with D2 lymph node dissection, distant metastases were recorded twice as often as in the group with D3 lymph node dissection — in 8 (11.8 %) and 4 (5.9 %) patients, respectively (p = 0.365). Local recurrence was not established in any case. The three-year overall and disease-free survival rates were 94.8 ± 3.0 and 100 % (p = 0.149) and 80.5 ± 5.8 and 88.7 ± 5.8 % (p = 0.177), respectively.Conclusions. The experience of using total mesocolonectomy with D3 lymph node dissection for RCC indicates the safety of this surgical intervention in comparison with traditional surgical techniques, while we did not obtain statistically significant differences in patient survival. To definitively determine the role of D3 lymph node dissection in the treatment of patients with RCC, large multicenter randomized studies are certainly needed.

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Section: Discussionunclassified

Comparative Analysis of the Outcomes of Laparoscopic Right Hemicolectomy with D2 and D3 Lymphadenectomy in the Treatment of Patients with Right Colon Cancer

Nevolskikh,

Avdeenko,

Mikhaleva

et al. 2024

Rossijskij žurnal gastroènterologii, gepatologii, koloproktolog

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“…There is no precise definition of the medial border of D2 lymph node dissection in the literature. In some studies, the medial border of D2 lymph node dissection is considered to be the lateral edge of the SMV [ 16 , 40 , 41 ], while others describe D2 lymph node dissection as a conventional right colectomy [ 42 ]. In our study, the medial border of D2 lymph node dissection was closer to the terminology used by Balciscueta.…”

Section: Discussionmentioning

confidence: 99%

Comparison of D2 vs D3 lymph node dissection for RIght COloN cancer (RICON): study protocol for an international multicenter open-label randomized controlled trial

Balaban,

Mutyk,

Bondarenko

et al. 2024

Trials

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Background Colon cancer is a global health concern, ranking fifth in both new diagnoses and deaths among tumors worldwide. Surgical intervention remains the primary treatment for localized cases, with a historical evolution marked by a focus on short-term outcomes. While Japan pioneered radical tumor removal with a systematic categorization of lymph nodes (D1, D2, D3), the dissemination of Japanese practices to the West was delayed until 90th of last century. Discrepancies between Japanese D3 dissection and the CME with CVL principle persist, with variations in longitudinal margins and recommended procedures. Non-randomized trials indicate the superiority of D3 over D2, but a consensus is lacking. Methods This prospective, international, multicenter, randomized controlled trial employs a two-arm, parallel-group, open-label design to rigorously compare the 5-year overall survival outcomes between D2 and D3 lymph node dissection in stage II-III right colon cancer. Building on prior studies, the trial aims to address existing knowledge gaps and provide a comprehensive evaluation of the outcomes associated with D3 dissection. The study population comprises patients with right colon cancer, ensuring a focused investigation into the specific context of this disease. The trial design emphasizes its global scope and collaboration across multiple centers, enhancing the generalizability of the findings. Discussion This study’s primary objective is to elucidate the potential superiority in 5-year overall survival benefits of D3 lymph node dissection compared to the conventional D2 approach in patients with stage II-III right colon cancer. By examining this specific subset of patients, the research aims to contribute valuable insights into optimizing surgical strategies for improved long-term outcomes. The trial’s international and multicenter nature enhances its applicability across diverse populations. The outcomes of this study may inform future guidelines and contribute to the ongoing discourse surrounding the standardization of colon cancer surgery, particularly in the context of right colon cancer. Trial registration ClinicalTrials.gov NCT03200834. Registered on June 27, 2017.

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“…This also reduces the rates of local recurrence and distant metastasis, thereby improving the survival rate. It is more conducive to the prognosis and has a better curative effect over the conventional D3 lymphadenectomy under a laparoscope for treating right-sided CRC guided by the SNV [12][13][14][15][16] . However, there are multiple variations in the blood vessels of the colon.…”

Section: Discussionmentioning

confidence: 99%

Application of spectral CT in D3 lymphadenectomy under a laparoscope for treating right-sided colorectal cancer

Zhang,

Shi,

Qiao

et al. 2023

Preprint

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Objective: The positive aspects of using spectral CT in D3 lymphadenectomy under a laparoscope for the treatment of right-sided colorectal cancer (CRC) are discussed. Methods: We enrolled right-sided CRC patients (n=40) and preoperative examinations by spectral CT revealed no distant metastasis. The pattern and orientation of the colon, tumor location, the positional correlation of lymph nodes and vessels, and the anatomy and alterations of key blood vessels were probed. Further, the relative spatial positions of different vessels were investigated using the 3D reconstruction technology of spectral CT. Finally, the results were compared with those observed during surgery. Results: Examination using spectral CT, 3D reconstruction, and data analysis were performed for all 40 cases with successful completion of all the surgeries. Overall, the pattern and orientation of the colon, tumor location, the relation of lymph nodes and blood vessels, and the anatomy and variation of key blood vessels observed during surgery were identical to the 3D reconstructed images obtained by spectral CT before the surgery. This suggests that the accuracy of 3D reconstruction reached 100%. Conclusion: The application of the 3D reconstruction technology of spectral CT before D3 lymphadenectomy under a laparoscope can help to visualize and determine the correlation between the location of a lesion and the anatomical location, hence assisting the surgery.

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Long-term oncologic outcome of D3 lymph node dissection for clinical stage 2/3 right-sided colon cancer

Cited by 6 publications

References 31 publications

Comparative Analysis of the Outcomes of Laparoscopic Right Hemicolectomy with D2 and D3 Lymphadenectomy in the Treatment of Patients with Right Colon Cancer

Comparative Analysis of the Outcomes of Laparoscopic Right Hemicolectomy with D2 and D3 Lymphadenectomy in the Treatment of Patients with Right Colon Cancer

Comparison of D2 vs D3 lymph node dissection for RIght COloN cancer (RICON): study protocol for an international multicenter open-label randomized controlled trial

Application of spectral CT in D3 lymphadenectomy under a laparoscope for treating right-sided colorectal cancer

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