Surgical and oncological outcomes of laparoscopic right hemicolectomy (D3 + CME) for colon cancer: A prospective single-center cohort study

Abstract

Background Complete mesocolic excision (CME) or D3 lymphadenectomy led to survival benefits for locally advanced right colon cancer, but with vague definitions in anatomy and debated surgical hazard in clinic. Aiming to achieve a precise definition of it in anatomy, we proposed laparoscopic right hemicolectomy (D3 + CME) as a novel procedure for colon cancer. However, the surgical and oncological results of this procedure in clinic were uncertain. Methods We performed a cohort study involving prospective data collected from a single-center in China. Data from all patients who underwent right hemicolectomy between January 2014 and December 2018 were included. We compared the surgical and oncological outcomes between D3 + CME and conventional CME. Results After implementation of exclusion criteria, a total of 442 patients were included. D3 + CME group performed better in lymph nodes harvested (25.0 [17.0, 33.8] vs. 18.0 [14.0, 25.0], P < 0.001) and the proportion of intraoperative blood loss ≥ 50 mL (31.7% vs. 51.8%, P < 0.001); no significant difference was observed in the complication rates between two groups. Kaplan–Meier analysis demonstrated that a better cumulative 5-year disease-free survival (91.3% vs. 82.2%, P = 0.026) and a better cumulative 5-year overall survival (95.2% vs. 86.1%, P = 0.012) were obtained in the D3 + CME group. Multivariate COX regression revealed that D3 + CME was an independent protective factor for disease-free survival (P = 0.026). Conclusion D3 + CME could improve surgical and oncological outcomes simultaneously for right colon cancer compared to conventional CME. Large-scale randomized controlled trials were further required to confirm this conclusion, if possible. Graphical Abstract

“Togetherness” of superior mesenteric vein and ileocolic artery: how 3D CT based understanding of unusual anatomy influences the approach to D3 lymph node dissection

“…The mean number of 15.9 ± 7.4 LNs were retrieved from artery-oriented D3 area in the cadaveric study (3). In the recent prospective single-center cohort study, conducted by Xiaolin et al, it was shown that the combination of the possible preservation of fascial integrity and central vascular ligation with proper landmarks (CME + D3) demonstrated improved cumulative survival outcomes, both disease-free and overall-survival rates (4).…”

“…Currently, there are two commonly accepted standards to D3LND: the rst approach considers SMV and its trunk as the main anatomical landmark, which should be dissected till the Henle's trunk (1,2). The second approach considers superior mesenteric artery at its left lateral side to include the watershed area of lymph node spread at the root of mesocolon (3)(4)(5). Thus, thorough understanding of spatial vascular anatomy is important to follow the landmarks of lymph dissection.…”