[Extensive lymphadenectomy and long-term survival in right hemicolectomy for carcinoma]

Late clinical outbreak in patients with right colon cancer translates into very advanced stage of the tumour. Nevertheless, long term results of radical surgery are favourable, even if susceptible of improvements. While earlier diagnoses are not easy to achieve, a greater surgical radicality can be obtained both by extending resections to the surrounding structures and organs, and by enlarging lymphadenectomy to all the inframesocolic compartment and to the main lymph nodes located at the level of superior mesenteric vessels. A series of 60 right hemicolectomies performed from 1968 to 1990 to treat right colonic cancer is presented. Intraoperative mortality was of 4 cases (6.6%). Lymph node "mapping" was drawn, and in 26 cases (43%) metastases were found. Paracolic nodes were involved in 96% of cases, intermediate in 42%, and principal ones in 34%. Forty four patients, surgically treated up to 1985 and eligible for a 5 year follow up, were all verified. Overall free of disease survival was assessed in 28 cases (63.6%). Survival in relation to Dukes staging was 81.8% (9/11) in C. According to presence (LN+) or absence (LN-) of lymphatic spread, 5 year survival was found to be 70.3% (19/27) in LN-, and 52.9 (9/17) in LN+. Difference between the two groups is 17.4%, much smaller than the mean one of 45% reported by world literature. This figure, together with the finding of a 12, 10 and 5 year survival in patients with principal nodes involvement, suggests that extended lymphadenectomy might play a principal role in improving long term survival rates of advanced right colon cancer.