Long-term oncologic results of laparoscopic D3 lymphadenectomy with complete mesocolic excision for right-sided colon cancer with clinically positive lymph nodes.

Abstract

To assess surgical outcomes of patients undergoing D3 lymph node dissection and complete mesocolic excision for the treatment of right-sided colon cancer in the context that both procedures were performed laparoscopically. 244 consecutive patients with clinically staged III right-sided colon cancer were recruited to undergo the laparoscopic D3 lymph node dissection with complete mesocolic excision. Postoperatively, the patients were stratified as N0, N1, N2, and N3 groups according to the level of lymph node metastasis, prospectively followed up for more than 5 years, and compared. The 5-year cumulative recurrence rate and the estimated time-to-recurrence [mean (95 % confidence interval)] was 16.6 % (n = 7/42), 113.8 (101.4-126.2) months in N0 group; 21.3 % (n = 17/80), 108.9 (99.1-118.7) months in N1 group; 43.2 % (n = 32/74), 85.4 (73.0-97.8) months in N2 group; and 52.0 % (n = 25/48), 65.2 (49.0-81.4) months in N3 group. When N1 and N0 groups of patients were lumped together, and compared with patients with N2 or N3 metastasis, we found that the latter were with a significantly higher recurrence rate (p < 0.0001). D3 lymph node dissection with complete mesocolic excision could assure the harvest of sufficient number (n = 34.4 ± 8.4) of lymph nodes for precise pathologic cancer staging. Skip lymph node metastasis was detected in 19.8 % (n = 40/202) of patients, and such surgical procedures facilitated up-staging in 4.5 % (n = 11/244) of patients. The present study encourages the dissemination of such concepts to surgical oncologists dealing with colorectal cancer through didactic education, and international consensus meeting is therefore mandatory to optimize the surgery of colon cancer.