Yadav K. Laparoscopic right radical hemicolectomy: Central vascular ligation and complete mesocolon excision vs D3 lymphadenectomy - How I do it? World J Gastrointest Surg 2024; 16(6): 1521-1526 [PMID: 38983361 DOI: 10.4240/wjgs.v16.i6.1521]
Corresponding Author of This Article
Kaushal Yadav, MBBS, MCh, MS, Surgical Oncologist, Department of Surgical Oncology, Max Hospital, Sushant Lok -1, Gurugram 122001, Haryana, India. kaushalyadavoo7@yahoo.com
Research Domain of This Article
Oncology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Jun 27, 2024; 16(6): 1521-1526 Published online Jun 27, 2024. doi: 10.4240/wjgs.v16.i6.1521
Laparoscopic right radical hemicolectomy: Central vascular ligation and complete mesocolon excision vs D3 lymphadenectomy - How I do it?
Kaushal Yadav
Kaushal Yadav, Department of Surgical Oncology, Max Hospital, Gurugram 122001, Haryana, India
Author contributions: Yadav K performed and depicts the surgical technique in the article.
Conflict-of-interest statement: Dr. Kaushal has nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kaushal Yadav, MBBS, MCh, MS, Surgical Oncologist, Department of Surgical Oncology, Max Hospital, Sushant Lok -1, Gurugram 122001, Haryana, India. kaushalyadavoo7@yahoo.com
Received: January 4, 2024 Revised: April 22, 2024 Accepted: May 8, 2024 Published online: June 27, 2024 Processing time: 177 Days and 20 Hours
Abstract
In colon cancer surgery, ensuring the complete removal of the primary tumor and draining lymph nodes is crucial. Lymphatic drainage in the colon follows the vascular supply, typically progressing from pericolic to paraaortic lymph nodes. While NCCN guidelines recommend the removal of 10-12 lymph nodes for adequate oncological resection, achieving complete oncological resection involves more than just meeting these numerical targets. Various techniques have been developed and studied over time to attain optimal oncological outcomes. A key technique central to this goal is identifying the ileocolic vessels at their origin from the superior mesenteric vessels. Complete excision of the visceral and parietal mesocolon ensures the intact removal of the specimen, while D3 lymphadenectomy targets all draining regional lymph nodes. Although these principles emphasize different aspects, they ultimately converge to achieve the same goal of complete oncological resection. This article aims to simplify the surgical steps that align with the principle of central vascular ligation and mesocolon mobilization while ensuring adequate D3 dissection.
Core Tip: Despite many decades of research, there is no consensus on standard surgical techniques for right-side colon cancer. The complete oncological resection is much more than simple number of harvested lymph nodes. Identifying the ileocolic vessels at their origin from superior mesenteric vessels is the central technique to serve this purpose. Complete visceral and parietal mesocolon excision removes the intact specimen. D3 lymphadenectomy removes all draining regional lymph nodes. Both principles serve the same goal with different emphases. So addressing adequate lymphadenectomy with complete negative margin R0 resection is central to this article.
