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Published on: March 24, 2023
Comparison of conventional resection to D3 lymphadenectomy in right-sided colon cancer: A retrospective cohort study
Praachi Raje1, Swati Sonal1, Hiroko Kunitake1
1Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
Background:
Lymphadenectomy during right hemicolectomy for colon cancer varies between the U.S. and Japan.
Methods:
Patients undergoing right hemicolectomy for non-metastatic right-sided colon cancer between 2010 and 2019 at U.S. and Japanese institutions were compared. Outcomes included survival, pathologic findings, and postoperative complications.
Results:
319 American patients (57 % female, mean age 70 years) underwent conventional resection and 308 Japanese patients (52 % female, mean age 70 years) underwent extended dissection. The conventional group underwent more laparotomies (26.6 % vs. 8.4 %, p < 0.001), had more poorly differentiated histology (31.7 % vs. 11.0 %, p < 0.01), lower lymph node yield (M = 27 ± 11 vs. M = 32 ± 14, p < 0.001), and more 30-day readmissions (31 vs. 5, p < 0.001). Adjusting for demographics, pathology, perioperative outcomes, and adjuvant chemotherapy, extended lymphadenectomy improved disease-free survival (HR 0.50; 95 % CI, 0.31-0.80; p = 0.004), but not overall survival (HR 0.98; 95 % CI, 0.95-1.02; p = 0.14).
Conclusions:
Extended lymphadenectomy for right sided-colon cancer improves disease-free, but not overall, survival among Japanese patients.
