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International Journal of Colorectal Disease

, Volume 24, Issue 3, pp 295–300 | Cite as

D3 lymphadenectomy using a medial to lateral approach for curable right-sided colon cancer

  • Seong Dae Lee
  • Seok-Byung Lim
Original Article

Abstract

Background and aims

The extended D3 lymphadenectomy using a medial to lateral (MtL) approach for the treatment of curable right-sided colon cancer is performed with a view to improving oncologic surgery outcomes. However, the feasibility and safety of this procedure has not been fully examined. The present study investigated the feasibility and safety of D3 lymphadenectomy using the MtL approach for curable right-sided colon cancers.

Methods

Between January 2005 and May 2007, 42 patients underwent a curative-intent right (25) or extended right (17) hemicolectomy including D3 lymphadenectomy using the MtL approach performed by the same single surgeon. The extent of the D3 lymphadenectomy followed the recommendations of the Japanese Society for Cancer of the Colon and Rectum.

Results

There were 27 male and 15 female patients, with a mean age of 59.2 years (range, 30–83). The mean operation time was 172.5 min (range, 55–274) and the mean blood loss was 128.3 ml (range, 50–500). All procedures were successful and no conversions to open surgery were required in laparoscopic cases (32 patients, 76.2%). The mean number of harvested lymph nodes was 45 (range, 18–92). There was no surgical mortality or morbidity, except one case of postoperative ileus which was conservatively managed. The mean postoperative hospital stay was 8.6 days (range, 6–15).

Conclusion

The findings indicate that a D3 lymphadenectomy using the MtL approach is a feasible and safe procedure for the treatment of curable right-sided colon cancer.

Keywords

Colonic neoplasm Colectomy Lymph node excision Medial to lateral approach 

References

  1. 1.
    Gervasoni JE Jr, Taneja C, Chung MA, Cady B (2000) Biologic and clinical significance of lymphadenectomy. Surg Clin North Am 80:1631–1673PubMedCrossRefGoogle Scholar
  2. 2.
    Slanetz CA Jr (1998) Effect of no touch isolation on survival and recurrence in curative resections for colorectal cancer. Ann Surg Oncol 5:390–398PubMedCrossRefGoogle Scholar
  3. 3.
    Slanetz CA Jr, Grimson R (1997) Effect of high and intermediate ligation on survival and recurrence rates following curative resection of colorectal cancer. Dis Colon Rectum 40:1205–1218PubMedCrossRefGoogle Scholar
  4. 4.
    Tagliacozzo S, Tocchi A (1997) extended mesenteric excision in right hemicolectomy for carcinoma of the colon. Int J Colorectal Dis 12:272–275PubMedCrossRefGoogle Scholar
  5. 5.
    Enker WE, Laffer UT, Block GE (1979) Enhanced survival of patients with colon and rectal cancer is based upon wide anatomic resection. Ann Surg 190:350–360PubMedCrossRefGoogle Scholar
  6. 6.
    Toyota S, Ohta H, Anazawa S (1995) Rationale for extent of lymph node dissection for right colon cancer. Dis Colon Rectum 38:705–711PubMedCrossRefGoogle Scholar
  7. 7.
    Nelson H, Petrelli N, Carlin A, Couture J, Fleshman J, Guillem J, Miedema B, Ota D, Sargent D (2001) Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst 93:583–596PubMedCrossRefGoogle Scholar
  8. 8.
    Le Voyer TE, Sigurdson ER, Hanlon AL, Mayer RJ, Macdonald JS, Catalano PJ, Haller DG (2003) Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol 21:2912–2919PubMedCrossRefGoogle Scholar
  9. 9.
    Chen SL, Bilchik AJ (2006) More extensive nodal dissection improves survival for stages I to III of colon cancer: a population-based study. Ann Surg 244:602–610PubMedGoogle Scholar
  10. 10.
    Chang GJ, Rodriguez-Bigas MA, Skibber JM, Moyer VA (2007) Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst 99:433–441PubMedCrossRefGoogle Scholar
  11. 11.
    Prandi M, Lionetto R, Bini A, Francioni G, Accarpio G, Anfossi A, Ballario E, Becchi G, Bonilauri S, Carobbi A, Cavaliere P, Garcea D, Giuliani L, Morziani E, Mosca F, Mussa A, Pasqualini M, Poddie D, Tonetti F, Zardo L, Rosso R (2002) Prognostic evaluation of stage B colon cancer patients is improved by an adequate lymphadenectomy. Ann Surg 235:458–463PubMedCrossRefGoogle Scholar
  12. 12.
    Tentes AA, Mirelis C, Karanikiotis C, Korakianitis O (2007) Radical lymph node resection of the retroperitoneal area for left-sided colon cancer. Langenbecks Arch Surg 392:155–160PubMedCrossRefGoogle Scholar
  13. 13.
    Japanese Society for Cancer of the Colon and Rectum (1997) Japanese Classification of Colorectal Carcinoma. Kanehara, TokyoGoogle Scholar
  14. 14.
    Okuno K (2007) Surgical treatment for digestive cancer. Current issues—colon cancer. Dig Surg 24:108–114PubMedCrossRefGoogle Scholar
  15. 15.
    Liang JT, Huang KC, Lai HS, Lee PH, Sun CT (2007) Oncologic results of laparoscopic D3 lymphadenectomy for male sigmoid and upper rectal cancer with clinically positive lymph nodes. Ann Surg Oncol 14:1980–1990PubMedCrossRefGoogle Scholar
  16. 16.
    Liang JT, Lai HS, Lee PH (2007) Laparoscopic medial-to-lateral approach for the curative resection of right-sided colon cancer. Ann Surg Oncol 14:1878–1879PubMedCrossRefGoogle Scholar
  17. 17.
    American Joint Committee on Cancer (2003) The sixth edition of the AJCC cancer staging. SpringerGoogle Scholar
  18. 18.
    Pigazzi A, Hellan M, Ewing DR, Paz BI, Ballantyne GH (2007) Laparoscopic medial-to-lateral colon dissection: how and why. J Gastrointest Surg 11:778–782PubMedCrossRefGoogle Scholar
  19. 19.
    Ballantyne GH, Ewing D, Pigazzi A, Wasielewski A (2006) Telerobotic-assisted laparoscopic right hemicolectomy: lateral to medial or medial to lateral dissection? Surg Laparosc Endosc Percutan Tech 16:406–410PubMedCrossRefGoogle Scholar
  20. 20.
    Hasegawa S, Kawamura J, Nagayama S, Nomura A, Kondo K, Sakai Y (2007) Medially approached radical lymph node dissection along the surgical trunk for advanced right-sided colon cancers. Surg Endosc 21:1657PubMedCrossRefGoogle Scholar
  21. 21.
    Wiggers T, Jeekel J, Arends JW, Brinkhorst AP, Kluck HM, Luyk CI, Munting JD, Povel JA, Rutten AP, Volovics A (1988) No-touch isolation technique in colon cancer: a controlled prospective trial. Br J Surg 75:409–415PubMedCrossRefGoogle Scholar
  22. 22.
    Turnbull RB Jr, Kyle K, Watson FR, Spratt J (1967) Cancer of the colon: the influence of the no-touch technique on survival rates. Ann Surg 166:420–427PubMedCrossRefGoogle Scholar
  23. 23.
    Hayashi N, Egami H, Kai M, Kurusu Y, Takano S, Ogawa M (1999) No-touch isolation technique reduces intraoperative shedding of tumor cells into the portal vein during resection of colorectal cancer. Surgery 125:369–374PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Center for Colorectal Cancer, Research Institute & HospitalNational Cancer CenterGoyang-siKorea
  2. 2.Department of Colon and Rectal SurgeryUniversity of Ulsan College of Medicine and Asan Medical CenterSeoulKorea

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