🔎D2 vs D3 Lymphadenectomy in Right-Sided Colon Cancer: What’s the Optimal Approach? скачать в хорошем качестве

🔎D2 vs D3 Lymphadenectomy in Right-Sided Colon Cancer: What’s the Optimal Approach?

In right hemicolectomy for colon cancer, the extent of lymphadenectomy remains a key question. Let’s break down the difference between D2 and D3 dissections — and whether it’s worth going further. 📌 Lymphadenectomy levels: • D2 — Removal of pericolic and intermediate lymph nodes along second-order vessels (ileocolic, right colic, and middle colic arteries). • D3 — Includes central lymph nodes at the root of the mesentery, near the origin of the superior mesenteric artery (SMA). 📊 Key data: • Central lymph node metastases are found in up to 11–13% of patients with clinically N0/N1 disease. • D3 dissection has shown a 6–8% increase in 5-year overall survival compared to D2, especially in pN1–N2 stages. • No significant increase in postoperative morbidity has been reported when performed in high-volume oncologic centers. 🧠 Surgical checkpoints during D3 dissection: 1. 🎯 Identify and divide the ileocolic artery at its root, not peripherally. 2. 🧭 Visualize and mobilize the SMA origin, staying close to vascular landmarks. 3. ✂️ Perform meticulous dissection while preserving the inferior pancreaticoduodenal vein and avoiding duodenal injury. 👨‍⚕️ Tips for young surgeons: • 🔪 Master the D2 technique first — focus on anatomy, hemostasis, and safe exposure. • 📸 Use intraoperative photos/videos for review and anatomical learning. • 💬 Discuss difficult steps with mentors — the mesenteric root is no place for compromise. • 🧾 Always document the lymphadenectomy level in the operative report — this is vital for oncologic staging and adjuvant therapy decisions. — 🏁 Today, D3 lymphadenectomy is emerging as the new standard in oncologic right colectomy, especially in stage II–III disease. Experience, anatomical knowledge, and oncologic reasoning are key to performing this procedure safely and effectively. ⸻ 🔁 Share your experience: Do you routinely perform D3 dissection in right colon cancer? What are the most common challenges you face during this step?