Comparison of short-term outcomes of D2 and D3 lymph nodes dissection for colon cancer

Abstract

Background. D3 lymph node dissection remains controversial in colon cancer surgery.Aim. To compare the short-term of D2 and D3 lymph nodes dissection for colon cancer.Materials and methods. Design of the study – prospective randomize controlled study. Inclusion criteria: age over 18 years, colon adenocarcinoma cT3–4n0–2m0, patient consent to participate in the study. Exclusion criteria: distant metastases diagnosed preoperatively, cTis–T2, cT4b (pancreas, stomach, small intestine, ureter, bladder, kidney), emergent cases (limited to tumor perforation, acute bowel obstruction), history of previous chemotherapy or radiation therapy, synchronous or metachronous cancer, pregnancy or breastfeeding, refusal to participate in the study. withdrawal criteria were exploratory laparotomy/laparoscopy or other reasons for refusing resection.Results. A total of 436 patients were included in the study no differences were found in the clinical characteristics of groups D2 and D3. In the D2 lymph node dissection group the incidence of unintentional vascular injuries was in 7 (3.2 %) patients, in the D3 lymph node dissection group – in 15 (6.9 %) patients (p = 0.12). The operating time increased by 30 minutes in D3 lymph node dissection group (p p = 0.42). Hartmann’s procedure was performed in 2 (0.9 %) patients in the D2 lymph node dissection group. Complications IIIb were recorded in 5 (2.3 %) and 9 (4.1 %) patients in lymph node dissection groups D2 and D3, respectively (p = 0.42). Anastomotic leakage was not observed in the D2 lymph node dissection group; in the D3 lymph node dissection group, it was diagnosed in 3 (1.4 %) patients (p = 0.25). postoperative multiple-organ failure (Iv) or mortality (v) were not observed. grade 3 quality of the specimen was observed in 160 (73.4 %) patients in the D2 lymph node dissection group, 163 (74.8 %) in the D3 lymph node dissection group (p = 0.79). The median number of lymph node harvested was 11 more in the D3 lymph node dissection group (p < 0.001). Apical lymph nodes were positive in 5 (2.3 %) patients in the D3 lymph node dissection group. There was no difference between the groups in R0 resection margin.Conclusion. D3 lymph node dissection is safe in terms of short-term outcomes in the treatment of colon cancer.