Lymph Node Distribution in the D3 Area of the Right Mesocolon

Spasojevic, Milan; Štimec, Bojan; Dyrbekk, Anne Pernille H.; Tepavčević, Zvezdana; Edwin, Bjørn; Bakka, Arne; Ignjatović, Dejan

doi:10.1097/01.dcr.0000436279.18577.d3

Cited by 68 publications

(33 citation statements)

References 9 publications

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“…In our meta-analysis, we found a wide range of anatomical variability of the major vascular structures, which suggests that surgical dissection during right hemicolectomy with CME-CVL is not straightforward, and should be done carefully, following the embryological planes. The D3 area has the following anatomical boundaries: (a) cranially – five mm proximal to the horizontal line through the Henle trunk and MCA origins; (b) caudally – five mm distal to the horizontal line through the origin of the ICA; (c) medially – the left edge of the SMA; (d) laterally – one cm from the right edge of the SMV 25 . Should be noted the difficulty of the CME-CVL surgical technique, which requires reflection of SMV to centrally ligate the colic arteries 68 .…”

Section: Discussionmentioning

confidence: 99%

Surgical Anatomy of the Superior Mesenteric Vessels Related to Colon and Pancreatic Surgery: A Systematic Review and Meta-Analysis

Negoi

Beuran

Hostiuc

et al. 2018

Sci Rep

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The surgeon dissecting the base of the mesenterium, around the superior mesenteric vein (SMV) and artery, is facing a complex tridimensional vascular anatomy and should be aware of the anatomical variants in this area. The aim of this systematic review is to propose a standardized terminology of the superior mesenteric vessels, with impact in colon and pancreatic resections. We conducted a systematic search in PubMed/MEDLINE and Google Scholar databases up to March 2017. Forty-five studies, involving a total of 6090 specimens were included in the present meta-analysis. The pooled prevalence of the ileocolic, right colic and middle colic arteries was 99.8%, 60.1%, and 94.6%, respectively. The superior right colic vein and Henle trunk were present in 73.9%, and 89.7% of specimens, respectively. In conclusion, the infra-pancreatic anatomy of the superior mesenteric vessels is widely variable. We propose the term Henle trunk to be used for any venous confluence between gastric, pancreatic and colic veins, which drains between the inferior border of the pancreas and up to 20 mm downward on the right-anterior aspect of the SMV. The term gastrocolic trunk should not be synonymous, but a subgroup of the Henle trunk, together with to gastropancreatocolic, gastropancreatic, or colopancreatic trunk.

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Section: Discussionmentioning

confidence: 99%

Surgical Anatomy of the Superior Mesenteric Vessels Related to Colon and Pancreatic Surgery: A Systematic Review and Meta-Analysis

Negoi

Beuran

Hostiuc

et al. 2018

Sci Rep

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“…Data collection is prospective. All these data points have been previously published [ 2 – 4 , 9 – 11 ] but will be addressed in short below. While the regional ethical committee approval allows any mode of access (open [ 10 ], laparoscopic [ 9 ], and robotic assisted), the study started out through open access while laparoscopic and robotic-assisted surgery were introduced at a later point.…”

Section: Methodsmentioning

confidence: 99%

“…The caudal border is 10 mm distal to the line connecting the ileocolic artery origin (ICA) and ileocolic vein confluence. The lateral border is placed 10 mm parallel to the right-hand side of the superior mesenteric vein (SMV) [ 2 , 3 ]. This definition was consistently used for postoperative division of the surgical specimen into the respective D3/D2 volumes.…”

Section: Methodsmentioning

confidence: 99%

“…D3 extended mesenterectomy entails the removal of all fatty tissue from the predefined D3 area [ 2 ], made possible and safe through preoperative 3D multi-detector computed tomography (MDCT) vascular anatomy reconstruction [ 3 , 4 ]. Literature suggests that the incidence of chylous ascites after surgery, i.e., urological, gynecological, vascular, and liver (non-intestinal lymph), is estimated to be between 0.17 and 7.0% [ 5 ], while the incidence rates may be higher after gastric, colorectal, pancreatic, and small bowel surgery (intestinal lymph) with a rate between 1.0 and 11.8% [ 1 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Preventing chylous ascites after right hemicolectomy with D3 extended mesenterectomy

Agustsdottir

Štimec

Stroemmen

et al. 2020

Langenbecks Arch Surg

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Background We aim to find the incidence of chylous ascites in patients undergoing D3 extended mesenterectomy and evaluate if a routine fat-reduced diet (FRD) has a prophylactic effect. Methods Data from 138 patients included in a D3 extended mesenterectomy trial were collected prospectively. Surgical drains and biochemical testing of drain fluid were used to find the incidence of chylous ascites among the first 39 patients, and a prophylactic fat-reduced diet was then implemented in the next 99 patients as a prophylactic measure. Results In the first 39 patients, we found that 16 (41.0%) developed chylous ascites. After the fat-reduced diet was implemented, 1 (1.0%) of 99 patients developed chylous ascites. Drain discharge was 150 vs. 80 mL daily, respectively, and a regression analysis shows the average leakage in the group with fat-reduced diet was 105 mL/day less than in the patients with no dietary restrictions (p < 0.001). There were no significant differences in the rate of other complications (Fisher exact test, one-tailed p = 0.8845), and although there was a tendency to a shorter hospital stay when given a fat-reduced diet (7.3 ± 5.4 vs. 8.9 ± 4.9 days), the difference was not significant (p = 0.19). Conclusions Chylous ascites is a very common postoperative occurrence after right colectomy with extended D3 mesenterectomy and may be prevented using a routine fat-reduced diet.

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“…13,14 However, the details of a correct D3 resection are still debated, and several studies have shown that there exists a significant variance of anatomical appearance in the left and right colon. In a recent paper by Spasjeovic et al, 15 they divided a predefined D3 area into 3 vertical compartments. In a postmortem study of 26 cadavers, they found that resection of the posterior vertical compartment had a potential of 5 to 6 additional lymph nodes.…”

Section: Lymph Node Harvestmentioning

confidence: 99%

Tailored Treatment of Colorectal Cancer: Surgical, Molecular, and Genetic Considerations

Augestad

Merok

Ignatovic

2017

Clin Med Insights Oncol

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Colorectal cancer (CRC) is a complex cancer disease, and approximately 40% of the surgically cured patients will experience cancer recurrence within 5 years. During recent years, research has shown that CRC treatment should be tailored to the individual patient due to the wide variety of risk factors, genetic factors, and surgical complexity. In this review, we provide an overview of the considerations that are needed to provide an individualized, patient-tailored treatment. We emphasize the need to assess the predictors of CRC, and we summarize the latest research on CRC genetics and immunotherapy. Finally, we provide a summary of the significant variations in the colon and rectal anatomy that is important to consider in an individualized surgical approach. For the individual patient with CRC, a tailored treatment approach is needed in the preoperative, operative, and postoperative phase.

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Lymph Node Distribution in the D3 Area of the Right Mesocolon

Abstract: Anatomically correct D3 resection implies posterior vertical compartment removal with posterior ileocolic artery crossing. Addition of the lateral vertical compartment to routine right colectomy has an improvement potential of 5 to 6 nodes.

Cited by 68 publications

References 9 publications

Surgical Anatomy of the Superior Mesenteric Vessels Related to Colon and Pancreatic Surgery: A Systematic Review and Meta-Analysis

Surgical Anatomy of the Superior Mesenteric Vessels Related to Colon and Pancreatic Surgery: A Systematic Review and Meta-Analysis

Preventing chylous ascites after right hemicolectomy with D3 extended mesenterectomy

Tailored Treatment of Colorectal Cancer: Surgical, Molecular, and Genetic Considerations

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