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

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Pattern of recurrence and survival after D2 right colectomy for cancer: is there place for a routine more extended lymphadenectomy?
Updates in Surgery ( IF 2.4 ) Pub Date : 2022-07-01 , DOI: 10.1007/s13304-022-01317-2
Matteo Palmeri ₁ , Andrea Peri ₂ , Valentina Pucci ₁ , Niccolò Furbetta ₁ , Virginia Gallo ₂ , Gregorio Di Franco ₁ , Anna Pagani ₃ , Chiara Dauccia ₃ , Camilla Farè ₂ , Desirée Gianardi ₁ , Simone Guadagni ₁ , Matteo Bianchini ₁ , Annalisa Comandatore ₁ , Gianluca Masi ₄ , Chiara Cremolini ₄ , Beatrice Borelli ₄ , Luca Emanuele Pollina ₅ , Giulio Di Candio ₁ , Andrea Pietrabissa ₂ , Luca Morelli _{1,

6}

Affiliation

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.

中文翻译：

癌症 D2 右结肠切除术后的复发和生存模式：是否有地方进行常规的更广泛的淋巴结清扫术？

背景

常规右侧结肠切除术联合 D2 淋巴结切除术 (RC-D2) 目前是右侧结肠癌 (RCC) 最常见的手术治疗方法。然而，它是否仍应被视为标准治疗，或被常规更广泛的 D3 淋巴结清扫术所取代，仍不清楚。在本研究中，我们旨在批判性地审查复发模式和从我们 11 年的 RC-D2 经验中获得的生存结果。

方法

回顾性分析了 2009 年 1 月至 2020 年 1 月在两个中心接受 RC-D2 治疗 RCC 的 489 名患者的临床数据。诊断时有同步远处转移和/或广泛淋巴结受累的患者被排除在外。评估术后临床病理特征和生存结果，包括疾病复发的模式。

结果

我们共招募了 400 名患者，并进行了信息随访。术后并发症发生率为 14%。中位随访时间为 62 个月。55 名患者 (13.8%) 出现癌症复发。其中40例（72.7%）发生全身转移，7例（12.8%）淋巴结受累。没有人在 D3 部位出现孤立的中央淋巴结转移 (CLM)。估计的 3 年和 5 年无复发生存率分别为 86.1% 和 84.4%。估计的 3 年和 5 年癌症特异性 OS 分别为 94.5% 和 92.2%。