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D3 Lymph Node Dissection in Right Hemicolectomy with a No-touch Isolation Technique in Patients With Colon Cancer

Kanemitsu, Yukihide M.D.1; Komori, Koji Ph.D.1; Kimura, Kenya Ph.D.1; Kato, Tomoyuki Ph.D.2

Diseases of the Colon & Rectum: July 2013 - Volume 56 - Issue 7 - p 815–824
doi: 10.1097/DCR.0b013e3182919093
Original Contributions: Colorectal/Anal Neoplasia

BACKGROUND: The role of lymph node dissection in the management of right-sided colon cancer remains controversial.

OBJECTIVE: The aim of this study was to investigate the surgical treatment of curable right-sided colon cancer by using D3 lymphadenectomy with a no-touch isolation technique and to determine the extent of lymph node dissection optimal for the prognosis of right-sided colon cancer.

DESIGN: This research is a retrospective cohort study from a prospectively collected database.

SETTING: The investigation took place in a specialized colorectal surgery department.

PATIENTS: Data on 370 consecutive patients who underwent D3 lymph node dissection for right-sided colon cancer with a no-touch isolation technique were identified.

MAIN OUTCOME MEASURES: The survival of patients with involvement of main nodes at the roots of colonic arterial trunks along superior mesenteric vessels through intermediate nodes in the right mesocolon was determined.

RESULTS: The 5-year overall survival of patients with stage I (n = 73, 19.7%), II (n = 155, 41.9%), and III (n = 142, 38.4%) cancer were 94.5%, 87.6%, and 79.2%. The 5-year disease-specific survival of patients with stages I, II, and III cancer were 100.0%, 94.5%, and 85.0%. Eleven patients (3.0%) had metastatic involvement of main lymph nodes, whereas 49 (13.2%) had metastases to intermediate lymph nodes. The 5-year overall survival and disease-specific survival of patients with metastases to main lymph nodes were 36.4% for both, and 5-year overall survival and disease-specific survival of patients with metastases to intermediate lymph nodes were 77.6% and 83.5%.

LIMITATIONS: This study was limited by its nonrandomized retrospective design.

CONCLUSIONS: D3 lymphadenectomy with a no-touch isolation technique allows curative resection and long-term survival in a cohort of patients with cancer of the right colon.

See related Editorial on p. 805

1 Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan

2 Department of Surgery, Kamiiida Daiichi General Hospital, Nagoya, Japan

Financial Disclosures: None reported.

Presented at a meeting of the Japan Surgical Association, Tokyo, Japan, November 17 to 19, 2011.

Correspondence: Yukihide Kanemitsu, M.D., Colorectal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. E-mail: ykanemit@ncc.go.jp

© 2013 The American Society of Colon and Rectal Surgeons