Propensity‐score‐matched analysis of <scp>D2</scp> and <scp>D3</scp> right hemicolectomy for colon cancer

Tan, Ming Ngan Aloysius; Liu, Biquan; Lin, Norman Sihan; Liu, Hui Min; Loong, Tse Han; How, Kwang Yeong; Lim, Gek Hsiang; Wong, Kar Yong

doi:10.1111/ans.17881

Cited by 7 publications

(6 citation statements)

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“…Therefore, as fewer lymph nodes are normally in the left colon, it is commonly recommended to perform central vascular ligation (CVL) in left hemicolectomy to achieve CME and obtain the highest possible number of retrieved lymph nodes [ 29 , 32 ]. Studies show that D3 right hemicolectomy also results in a larger harvested lymph node yield without increasing morbidity and even mortality [ 33 , 34 ]. The need for CME in right colectomy surgery is therefore debated.…”

Section: Discussionmentioning

confidence: 99%

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Short- and long-term outcome differences between patients undergoing left and right colon cancer surgery: cohort study

Kuliavas,

Marcinkevičiūtė,

Baušys

et al. 2024

Int J Colorectal Dis

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Purpose Since the literature currently provides controversial data on the postoperative outcomes following right and left hemicolectomies, we carried out this study to examine the short- and long-term treatment outcomes. Methods This study included consecutive patients who underwent right or left-sided colonic resections from year 2014 to 2018 and then they were followed up. The short-term outcomes such as postoperative morbidity and mortality according to Clavien-Dindo score, duration of hospital stay, and 90-day readmission rate were evaluated as well as long-term outcomes of overall survival and disease-free survival. Multivariable Cox regression analysis was performed of overall and progression-free survival. Results In total, 1107 patients with colon tumors were included in the study, 525 patients with right-sided tumors (RCC) and 582 cases with tumors in the left part of the colon (LCC). RCC group patients were older (P < 0.001), with a higher ASA score (P < 0.001), and with more cardiovascular comorbidities (P < 0.001). No differences were observed between groups in terms of postoperative outcomes such as morbidity and mortality, except 90-day readmission which was more frequent in the RCC group. Upon histopathological analysis, the RCC group’s patients had more removed lymph nodes (29 ± 14 vs 20 ± 11, P = 0.001) and more locally progressed (pT3-4) tumors (85.4% versus 73.4%, P = 0.001). Significantly greater 5-year overall survival and disease-free survival (P = 0.001) were observed for patients in the LCC group, according to univariate Kaplan-Meier analysis. Conclusions Patients with right-sided colon cancer were older and had more advanced disease. Short-term surgical outcomes were similar, but patients in the LCC group resulted in better long-term outcomes.

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Section: Discussionmentioning

confidence: 99%

“…Nevertheless, recent studies and ongoing trial results have shown that extended lymphadenectomy has oncological benefits in colorectal cancer for better staging [ 35 , 37 ]. Moreover, that results in decreased local recurrence rates and thus in lower overall mortality rates [ 29 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Short- and long-term outcome differences between patients undergoing left and right colon cancer surgery: cohort study

Kuliavas,

Marcinkevičiūtė,

Baušys

et al. 2024

Int J Colorectal Dis

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“…Сторонники расширенной лимфодиссекции при РППОК приводят в качестве аргумента за использование данной методики тот факт, что ее применение способствует удалению большего количества лимфатических узлов [2,12,[20][21][22], что косвенно должно оказывать влияние и на улучшение отдаленных результатов лечения. И, действительно, в нашем исследовании мы отметили увеличение общего количества удаленных лимфатических узлов при D3-в сравнении с D2-диссекцией -19 Рос журн гастроэнтерол гепатол колопроктол 2024; 34(1) / Rus J Gastroenterol Hepatol Coloproctol 2024; 34 (1) Оригинальные исследования/Original articles и 14 (1-52) соответственно (р < 0,001).…”

Section: Discussionunclassified

“…В частности, M.N. Tan et al [22], также использовавшие в своей работе при сравнении пациентов с D2-и D3-лимфодиссекцией метод псевдорандомизации, выявили 23 (18-29) лимфатических узла при D2-лимфодиссекции и 26 (21-34) -при D3-диссекции (p = 0,005). Практически идентичные результаты были получены в многоцентровом рандомизированном исследовании RELARC -23 (17, и 26 (19-35) (р < 0,0001) [11].…”

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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“…In the Japanese Classification of Colorectal Cancer, 1 dissection of lymph nodes (LNs) around the root regions of tumor-feeding arteries is defined as “D3 lymph node dissection.” D3 has yielded significantly better oncological outcomes in patients with colon cancer than those of D2 LN dissection (D2), which does not involve the dissection of LNs around the root regions of tumor-feeding arteries. 2,3 Therefore, D3 could be beneficial for certain cecal and ascending colon cancer patients with lymph node metastases. However, vascular anatomy leads to differences in the precision of D3.…”

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Robotic True D3 Lymph Node Dissection With Superior Mesenteric Vein–Taping Technique for Right-Sided Colon Cancer

Ishizaki,

Mazaki,

Kasahara

et al. 2024

Diseases of the Colon &Amp; Rectum

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BACKGROUND: D3 is unaffected by anatomical factors even when the ileocolic artery runs along the dorsal side of the superior mesenteric vein. Complete “true D3” lymph node dissection in minimally invasive surgery for right colon cancer could be beneficial for certain patients with lymph node metastases. IMPACT OF INNOVATION: The study aimed to determine the safety and feasibility of robotic true D3 lymph node dissection for right colon cancer using a superior mesenteric vein taping technique. TECHNOLOGY MATERIALS AND METHODS: The superior mesenteric vein was slowly and gently separated from the surrounding tissues and taped. Lifting the tape with the robotic third arm and fixing it in place using rock-stable tractions provides a good surgical view, which cannot otherwise be obtained. As a result, the ileocolic artery that branches from the superior mesenteric artery can be accurately exposed. Handling of the taping then enables expansion to a different surgical view. As the lymph nodes are originally concealed on the dorsal side of the superior mesenteric vein, this technique provides a good view for lymph node dissection. The root of the ileocolic artery was clipped and separated, and true D3 was thus completed. PRELIMINARY RESULTS: Fourteen patients underwent robotic true D3 lymph node dissection for right colon cancer. No Clavien-Dindo classification Grade II or higher intraoperative or postoperative complications were observed. The 30-day mortality rate was 0%. CONCLUSIONS: Our robotic true D3 lymph node dissection with superior mesenteric vein taping technique is considered safe and feasible; it might be a promising surgical procedure for treating advanced right colon cancer. FUTURE DIRECTIONS: Even when the ileocolic artery runs along the dorsal aspect of the superior mesenteric vein, the technique seems promising for facilitating robotic D3 lymph node dissection. See Video.

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Propensity‐score‐matched analysis of D2 and D3 right hemicolectomy for colon cancer

Abstract: Not a recipient of any research scholarships.

Cited by 7 publications

References 20 publications

Short- and long-term outcome differences between patients undergoing left and right colon cancer surgery: cohort study

Short- and long-term outcome differences between patients undergoing left and right colon cancer surgery: cohort study

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

Robotic True D3 Lymph Node Dissection With Superior Mesenteric Vein–Taping Technique for Right-Sided Colon Cancer

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