Short-term outcomes of vessel-oriented D2 and D3 lymph node dissection for sigmoid colon cancer

Level of lymph nodes dissection (LND) and inferior mesenteric artery (IMA) ligation is still matter of debate of radical resection of colorectal cancer. This study aims to compare the short-term outcome of three different surgical techniques to treat sigmoid cancer: low ligation (LL) of the IMA with D3-LND, low IMA ligation with D2-LND, and high ligation (HL) of the IMA with D3-LND.

Patients affected by sigmoid colon cancer, who underwent radical resection with three different techniques (LL and D3-LND Group A, HL and D3-LND Group B, and LL with D2 LND- Group C), were included. Operative time (min), blood loss (ml), early postoperative complications, and number of harvested lymph nodes were compared.

Thirty patients per group were enrolled. The median operation time was shorter in group C (130 min, interquartile range [IQR] 120-140), compared with the 245 min (IQR 193.8-295.5) of group A and 257 min (IQR 183-345) of group B, p < 0.005. No significant differences between A and B group were observed in the median intraoperative blood loss, while group C had higher intraoperative blood loss (200 ml, IQR 200-260, p = 0.002). Anastomotic leak occurred in three patients belonging to group B. A reduced number of harvested lymph nodes was registered in Group C (14 lymph nodes, IQR 10-17), p < 0.005.

Both high and low tie ligation with D3-LND for sigmoid cancer can be considered safe and feasible with low rate of postoperative complications, allowing a higher number of harvested lymph nodes compared to low tie ligation with D2 lymphadenectomy.