D3 Lymphadenectomy for Right Colon Cancer: Feasibility, Safety, and Early Outcomes from a District General Hospital in London.

IF 0.8 Q4 SURGERY
Chirurgia Pub Date : 2024-08-01 DOI:10.21614/chirurgia.3026
Valentin Butnari, Timothy Jones, Ahmer Mansuri, Maitreyi Patel, Victor Kung, Saswata Banerjee, Nirooshun Rajendran, Joseph Huang, Richard Boulton, Sandeep Kaul
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引用次数: 0

Abstract

Background and objectives: Observational studies suggest a link between D3 lymphadenectomy and improved disease-free survival in some colon cancer patients. However, high-quality randomized controlled trials are needed to confirm its advantage over D2 lymphadenectomy. Concerns about potential complications with D3 have limited its use outside of Japan. This study examines short-term outcomes following D3 lymphadenectomy for right-sided colon cancer compared to the established D2 procedure. Materials and Methods: This retrospective cohort single center study analyzed data on patients with right-sided colon cancer who underwent curative surgery within our healthcare trust between January 2019 and November 2022. Only patients treated by surgeons who routinely perform D3 lymphadenectomy were included for a homogenous study population. The decision to perform D3 was at the discretion of the operating surgeon. Data were collected from both paper charts and electronic medical records. Non-parametric statistical tests were used for data analysis. Results: A total of 214 patients met the criteria, with 170 undergoing D2 lymphadenectomy and 44 undergoing D3 lymphadenectomy. There were no significant differences between the groups in terms of surgery duration, blood loss, postoperative hemoglobin levels, or transfusion needs. Interestingly, the D3 group had a lower complication rate (25%) compared to the D2 group (41.2%). However, the D3 group also had a higher rate of lymph node spread (45.5% vs. 30.6% for D2) and more lymph nodes removed (19 [16, 25] vs. 23 [18, 28]). Importantly, both groups achieved similar complete tumour removal rates. Conclusions: This study suggests D3 lymphadenectomy for right-sided colon cancer might be safe with potential benefits, especially for younger patients with suspected lymph node involvement. However, the limited sample size necessitates larger, randomized trials to confirm these findings and potentially establish D3 lymphadenectomy as standard care.

右结肠癌 D3 淋巴腺切除术:伦敦一家地区综合医院的可行性、安全性和早期疗效。
背景和目的:观察性研究表明,D3 淋巴腺切除术与部分结肠癌患者无病生存率的提高有关。然而,还需要高质量的随机对照试验来证实其优于 D2 淋巴腺切除术。由于对D3淋巴结切除术潜在并发症的担忧,限制了它在日本以外地区的使用。本研究探讨了右侧结肠癌 D3 淋巴腺切除术与成熟的 D2 手术相比的短期疗效。材料和方法:这项回顾性队列单中心研究分析了 2019 年 1 月至 2022 年 11 月期间在我们的医疗信托机构内接受根治性手术的右侧结肠癌患者的数据。为保证研究人群的同质性,仅纳入了由常规实施 D3 淋巴腺切除术的外科医生治疗的患者。是否进行 D3 淋巴腺切除术由手术外科医生决定。数据收集自纸质病历和电子病历。数据分析采用非参数统计检验。结果共有 214 名患者符合标准,其中 170 人接受了 D2 淋巴腺切除术,44 人接受了 D3 淋巴腺切除术。两组患者在手术时间、失血量、术后血红蛋白水平或输血需求方面没有明显差异。有趣的是,D3 组的并发症发生率(25%)低于 D2 组(41.2%)。不过,D3 组的淋巴结扩散率也更高(45.5% 对 D2 组的 30.6%),切除的淋巴结也更多(19 [16, 25] 对 23 [18, 28])。重要的是,两组的肿瘤完全切除率相似。结论:这项研究表明,右侧结肠癌的 D3 淋巴结切除术可能是安全的,并具有潜在的益处,尤其是对于疑似淋巴结受累的年轻患者。然而,由于样本量有限,有必要进行更大规模的随机试验来证实这些研究结果,并有可能将 D3 淋巴腺切除术确立为标准治疗方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Chirurgia
Chirurgia Medicine-Surgery
CiteScore
1.00
自引率
0.00%
发文量
75
审稿时长
4-8 weeks
期刊介绍: Chirurgia is a bimonthly journal. In Chirurgia, original papers in the area of general surgery which neither appeared, nor were sent for publication in other periodicals, can be published. You can send original articles, new surgical techniques, or comprehensive general reports on surgical topics, clinical case presentations and, depending on publication space, - reviews of some articles of general interest to surgeons from other publications. Chirurgia is also a place for sharing information about the activity of various branches of the Romanian Society of Surgery, information on Congresses and Symposiums organized by the Romanian Society of Surgery and participation notes in other scientific meetings. Letters to the editor: Letters commenting on papers published in Chirurgia are welcomed. They should contain substantive ideas and commentaries supported by appropriate data, and should not exceed 2 pages. Please submit these letters to the editor through our online system.
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