Pattern of recurrence and survival after D2 right colectomy for cancer: is there place for a routine more extended lymphadenectomy?

Abstract

BACKGROUND:

Conventional Right Colectomy with D2 lymphadenectomy (RC-D2) currently represent the most common surgical treatment of right-sided colon cancer (RCC). However, whether it should be still considered a standard of care, or replaced by a routine more extended D3 lymphadenectomy remains unclear. In the present study, we aim to critically review the patterns of relapse and the survival outcomes obtained from our 11-year experience of RC-D2.

METHODS:

Clinical data of 489 patients who underwent RC-D2 for RCC at two centres, from January 2009 to January 2020, were retrospectively reviewed. Patients with synchronous distant metastases and/or widespread nodal involvement at diagnosis were excluded. Post-operative clinical-pathological characteristics and survival outcomes were evaluated including the pattern of disease relapse.

RESULTS:

We enrolled a total of 400 patients with information follow-up. Postoperative morbidity was 14%. The median follow-up was 62 months. Cancer recurrence was observed in 55 patients (13.8%). Among them, 40 patients (72.7%) developed systemic metastases, and lymph-node involvement was found in 7 cases (12.8%). None developed isolated central lymph-node metastasis (CLM), in the D3 site. The estimated 3- and 5-year relapse-free survival were 86.1% and 84.4%, respectively. The estimated 3- and 5-year cancer-specific OS were 94.5% and 92.2%, respectively.

CONCLUSIONS:

The absence of isolated CLM, as well as the cancer-specific OS reported in our series, support the routine use of RC-D2 for RCC. However, D3 lymphadenectomy may be recommended in selected patients, such as those with pre-operatively known CLM, or with lymph-node metastases close to the origin of the ileocolic vessels.

• Authors: Matteo Palmeri, Andrea Peri, Valentina Pucci, Niccolò Furbetta, Virginia Gallo, Gregorio Di Franco, Anna Pagani, Chiara Dauccia, Camilla Farè, Desirée Gianardi, Simone Guadagni, Matteo Bianchini, Annalisa Comandatore, Gianluca Masi, Chiara Cremolini, Beatrice Borelli, Luca Emanuele Pollina, Giulio Di Candio, Andrea Pietrabissa, Luca Morelli
• Journal: Updates in surgery (Updates Surg) Vol. 74 Issue 4 Pg. 1327-1335 (Aug 2022) ISSN: 2038-3312 [Electronic] Italy
• PMID: 35778547 (Publication Type: Journal Article)
• Copyright: © 2022. The Author(s).

Topics

• Carcinoma, Renal Cell (surgery)
• Colectomy
• Colonic Neoplasms
• Humans
• Kidney Neoplasms (surgery)
• Laparoscopy
• Lymph Node Excision
• Lymphatic Metastasis
• Neoplasm Recurrence, Local (surgery)
• Retrospective Studies