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For: Nesgaar JM, Stimec BV, Bakka AO, Edwin B, Bergamaschi R, Ignjatovic D. Right Colectomy with Extended D3 Mesenterectomy: Anterior and Posterior to the Mesenteric Vessels. Surg Technol Int. 2019;35:138-142. [PMID: 31237343 DOI: 10.1007/s10353-019-0604-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]

For:	Nesgaar JM, Stimec BV, Bakka AO, Edwin B, Bergamaschi R, Ignjatovic D. Right Colectomy with Extended D3 Mesenterectomy: Anterior and Posterior to the Mesenteric Vessels. Surg Technol Int. 2019;35:138-142. [PMID: 31237343 DOI: 10.1007/s10353-019-0604-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]

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Cited by Other Article(s)

Nevolskikh AA, Avdeenko VA, Reznik IP, Pochuev TP, Zibirov RF, Ivanov SA, Kaprin AD. Surgical treatment of right colon cancer. SIBERIAN JOURNAL OF ONCOLOGY 2024;23:133-149. [DOI: 10.21294/1814-4861-2024-23-3-133-149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]

Abstract The study aimed to perform a systematic review of the literature on surgical treatment for right colon cancer (RCC) with complete mesocolic excision (CME) and D2/D3 lymph node dissection (LND). Material and Methods. A literature review was performed for studies published between 2013 and 2023 by the online resources from the official Web sites of the societies/panels and PubMed database. Sources included guidelines, meta-analyses, randomized and nonrandomized clinical studies, guidelines by European Society of Medical Oncology, the Japanese Society for Cancer of the Colon and Rectum, and the National Comprehensive Cancer Network, Russian clinical guidelines. Results. CME significantly improved both immediate and long-term treatment results, which was confirmed by numerous meta-analyses. The extent of LND remains one of the most controversial issues in RCC. For many Asian surgeons, D3 LND is the standard procedure for the treatment of RCC, whereas the European approach is more conservative and apical lymph node dissection is not mandatory. There are also large differences in understanding the extent of D3 LND in RCC. Most surgeons understand this term as dissection of adipose tissue along the anterior and lateral surface of the superior mesenteric vein, however, there are authors who perform circular dissection along the superior mesenteric vessels, considering this extent of surgery to be the most radical. Conclusion. It is necessary to standardize methods and effective criteria for quality control of CME for RCC and LND. In this case, external independent assessment of the quality of surgical intervention is important. There is also currently a growing number of studies in which intraoperative fluorescence imaging makes it possible to better visualize the location of the apical lymph nodes and individualize LND. Collapse

Banipal GS, Stimec BV, Andersen SN, Edwin B, Nesgaard JM, Šaltytė Benth J, Ignjatovic D. Are Metastatic Central Lymph Nodes (D3 volume) in right-sided Colon Cancer a Sign of Systemic Disease? A sub-group Analysis of an Ongoing Multicenter Trial. Ann Surg 2024;279:648-656. [PMID: 37753647 PMCID: PMC10922660 DOI: 10.1097/sla.0000000000006099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]

Abstract

OBJECTIVE

Assess outcomes of patients with right-sided colon cancer with metastases in the D3 volume after personalized surgery.

BACKGROUND

Patients with central lymph node metastasis (D3-PNG) are considered to have a systemic disease with a poor prognosis. A 3-dimensional definition of the dissection volume allows the removal of all central nodes.

MATERIALS AND METHODS

D3-PNG includes consecutive patients from an ongoing clinical trial. Patients were stratified into residual disease negative (D3-RDN) and residual disease positive (D3-RDP) groups. D3-RDN was further stratified into 4 periods to identify a learning curve. A personalized D3 volume (defined through arterial origins and venous confluences) was removed " en bloc" through medial-to-lateral dissection, and the D3 volume of the specimen was analyzed separately.

RESULTS

D3-PNG contained 42 (26 females, 63.1 SD 9.9 y) patients, D3-RDN:29 (17 females, 63.4 SD 10.1 y), and D3-RDP:13 (9 females, 62.2 SD 9.7 y). The mean overall survival (OS) days were D3-PNG:1230, D3-RDN:1610, and D3-RDP:460. The mean disease-free survival (DFS) was D3-PNG:1023, D3-RDN:1461, and D3-RDP:74 days. The probability of OS/DFS were D3-PNG:52.1%/50.2%, D3-RDN:72.9%/73.1%, D3-RDP: 7.7%/0%. There is a significant change in OS/DFS in the D3-RDN from 2011-2013 to 2020-2022 (both P =0.046) and from 2014-2016 to 2020-2022 ( P =0.028 and P =0.005, respectively).

CONCLUSION

Our results indicate that surgery can achieve survival in most patients with central lymph node metastases by removing a personalized and anatomically defined D3 volume. The extent of mesenterectomy and the quality of surgery are paramount since a learning curve has demonstrated significantly improved survival over time despite the low number of patients. These results imply a place for the centralization of this patient group where feasible.

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Liu S, Li L, Sun H, Chen B, Yu M, Zhong M. D3 Versus D2 Lymphadenectomy in Right Hemicolectomy: A Systematic Review and Meta-analysis. Surg Innov 2022;29:416-425. [PMID: 35102792 DOI: 10.1177/15533506211060230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]

Costa G, Fransvea P, Lepre L, Rondelli F, Costa A, Campanelli M, Lisi G, Mastrangeli MR, Laracca GG, Garbarino GM, Ceccarelli G. 2D vs 3D laparoscopic right colectomy: A propensity score-matching comparison of personal experience with systematic review and meta-analysis. World J Gastrointest Surg 2021;13:597-619. [PMID: 34194617 PMCID: PMC8223707 DOI: 10.4240/wjgs.v13.i6.597] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/04/2021] [Accepted: 05/18/2021] [Indexed: 02/06/2023] Open

Abstract

BACKGROUND

The benefits of laparoscopic approach for right colectomy have been well established. However, the technical difficulty to construct the intra-corporeal anastomosis is still cumbersome.

AIM

To analyze the results of 3D and 2D laparoscopic right colectomy and to compare it to the published series through a systematic review and meta-analysis.

METHODS

A retrospective study with propensity score matching analysis of patients undergoing laparoscopic right colectomy at Umbria2 Hospitals from January 2014 to March 2020 was performed. A systematic review was accomplished comparing 2D and 3D right colectomy.

RESULTS

In the personal series 47 patients of the 2D group were matched to 47 patients of the 3D group. The 3D group showed a favorable trend in terms of mean operative time (170.7 ± 32.9 min vs 183.8 ± 35.4 min; P = 0.053) and a significant lower anastomotic time (16.9 ± 2.3 min vs 19.6 ± 2.9 min, P < 0.001). The complete mesocolic excision (CME) subgroups analysis showed a shorter anastomotic time (16.5 ± 1.8 min vs 19.9 ± 3.0 min; P < 0.001) and operative time (175.0 ± 38.5 min vs 193.7 ± 37.1 min; P = 0.063) in the 3D group. Six studies and our series were included in the meta-analysis with 551 patients (2D group: 291; 3D group: 260).The pooled analysis demonstrated a significant difference in favour of the 3D group regarding the operative time (P < 0.001) and the anastomotic time (P < 0.001) while no differences were identified between groups in terms of blood loss (P = 0.827), LNH yield (P = 0.243), time to first flatus (P = 0.333), postoperative complications (P = 0.718) and length of stay (P = 0.835).

CONCLUSION

The meta-analysis results showed that 3D laparoscopic right colectomy shortens operative and anastomotic time without affecting the standard lymphadenectomy. In our series, the advantage of the 3D system becomes evident when CME and/or more complex associated procedure are requested significantly reducing both the total operative and the anastomotic time.

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