Impact of D3 lymph node dissection on upstaging and short-term survival in clinical stage I right-sided colon cancer

Effect of preoperative colonoscopy combined with preservation of the right vein of the gastric omentum during radical resection of intestinal cancer on the efficacy and prognostic indicators of the procedure

BACKGROUND

The aim of this study was to investigate the clinical value of preoperative colonoscopy combined with right gastroepiploic vein preservation (RGV) in radical resection of colorectal cancer for right colon cancer.

METHODS

A total of 120 patients with right colon cancer in our hospital from February 2019 to October 2021 were selected and randomly divided into study group (RGV preserved during operation) and control group (RGV not preserved during operation), with 60 cases in each group. Perioperative parameters, intestinal fatty acid binding protein (I-FABP), Pittsburgh Sleep Quality Index (PSQI), total protein (TP), D-lactate (D-LA), quality of life scale (SF-36) scores, incidence of complications, and tumor recurrence rate were compared between the two groups.

RESULTS

Duration of hospitalization was shorter in the study group than in the control group (P<0.05). Six months after surgery, I-FABP, D-LA levels and PSQI scores were lower, and TP levels and SF-36 scores were higher in the study group than in the control group (P<0.05). The incidence of complications in the study group (11.67% vs. 33.33%) was lower than that in the control group (P<0.05). There was no significant difference in tumor recurrence rate 6 months after operation between the two groups (P>0.05).

CONCLUSIONS

Preoperative colonoscopy combined with RGV preservation in radical resection of colorectal cancer for right colon cancer can avoid surgical trauma caused by unnecessary transection, reduce gastrointestinal function damage, promote physical rehabilitation and shorten hospital stay, and reduce the risk of complications such as gastroparesis.

The concept of developmental anatomy: the greater omentum should be resected in right-sided colon cancer?

BACKGROUND

The greater omentum is derived from the foregut, and the right hemicolon is derived from the midgut based on developmental anatomy. This study aimed to investigate whether the greater omentum should be resected in laparoscopic complete mesocolic excision based on developmental anatomy for right-sided colon cancer.

METHODS

A total of 183 consecutive patients with right-sided colon cancer were recruited in this study between February 2020 and July 2022. Ninety-eight patients underwent standard laparoscopic complete mesocolic excision surgery (CME group). The presence of isolated tumor cells and micrometastases was detected in resected greater omentum by the HE staining and immunohistochemistry analysis. Based on developmental anatomy, laparoscopic CME surgery with greater omentum preservation (DACME group) was proposed and performed on 85 right-sided colon cancer patients. To overcome selection bias, we performed a 1:1 match between two groups using four variables: age, sex, BMI, and ASA scores.

RESULTS

No isolated tumor cells and micrometastases were found in the resected greater omentum specimen in the CME group. After the propensity score, 81 pairs were balanced and analyzed. Patients in the DACME group showed shorter operative time (194.9 ± 16.4 min vs.201.5 ± 11.5 min, p = 0.002), less blood loss (23.5 ± 24.7 ml vs.33.6 ± 26.3 ml, p = 0.013), and the shorter hospital stays (9.6 ± 1.7 days vs.10.3 ± 2.0 days, p = 0.010) compared with patients in the CME group. In addition, patients in the DACME group had a lower incidence of postoperative complications (4.9% vs.14.8%, p = 0.035) than patients in the CME group.

CONCLUSION

The greater omentum should be preserved during right-sided colon cancer surgery, laparoscopic CME surgery based on developmental anatomy is technically safe and feasible for right-sided colon cancer.

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

PURPOSE

To investigate oncologic outcomes including overall survival and disease-free survival depending on the extent of lymphadenectomy (D3 versus D2) by comparing D3 and D2 lymphadenectomy in patients with clinical stage 2/3 right colon cancer.

METHODS

Consecutive series of patients who underwent radical resection for right colon cancer at our three hospitals between January 2015 and June 2018 were retrospectively analyzed. Study cohorts were divided into two groups: D3 group and D2 group. Oncologic, pathologic, and perioperative outcomes of the two groups were compared.

RESULTS

A total of 295 patients (167 in the D2 group and 128 in the D3 group) were included in this study. Patients' characteristics showed no significant difference between the two groups. The median number of harvested lymph nodes was significantly higher in the D3 group than in the D2 group. The rate of complications was not significantly different between the two groups except for chyle leakage, which was more frequent in the D3 group. Five-year disease-free survival was 90.2% (95% CI: 84.8-95.9%) in the D3 group, which was significantly (p = 0.028) higher than that (80.5%, 95% CI: 74-87.5%) in the D2 group. There was no significant difference in overall survival between the two groups.

CONCLUSION

Our results indicate that D3 lymphadenectomy is associated with more favorable 5-year disease-free survival than D2 lymphadenectomy for patients with stage 2/3 right-sided colon cancer. D3 lymphadenectomy might improve oncologic outcomes in consideration of the recurrence rate.

Definition and reporting of lymphadenectomy and complete mesocolic excision for radical right colectomy: a systematic review

BACKGROUND

Several procedures have been proposed to reduce the rates of recurrence in patients with right-sided colon cancer. Different procedures for a radical right colectomy (RRC), including extended D3 lymphadenectomy, complete mesocolic excision and central vascular ligation have been associated with survival benefits by some authors, but results are inconsistent. The aim of this study was to assess the variability in definition and reporting of RRC, which might be responsible for significant differences in outcome evaluation.

METHODS

PRISMA-compliant systematic literature review to identify the definitions of RRC. Primary aims were to identify surgical steps and different nomenclature for RRC. Secondary aims were description of heterogeneity and overlap among different RRC techniques.

RESULTS

Ninety-nine articles satisfied inclusion criteria. Eight surgical steps were identified and recorded as specific to RRC: Central arterial ligation was described in 100% of the included studies; preservation of mesocolic integrity in 73% and dissection along the SMV plane in 67%. Other surgical steps were inconstantly reported. Six differently named techniques for RRC have been identified. There were 35 definitions for the 6 techniques and 40% of these were used to identify more than one technique.

CONCLUSIONS

The only universally adopted surgical step for RRC is central arterial ligation. There is great heterogeneity and consistent overlap among definitions of all RRC techniques. This is likely to jeopardise the interpretation of the outcomes of studies on the topic. Consistent use of definitions and reporting of procedures are needed to obtain reliable conclusions in future trials. PROSPERO CRD42021241650.