Exploration of the medial border for laparoscopic D3 lymph node dissection in right hemi-colon cancer: a systematic
Minchen Wang1, Zhiyuan Li1, Xin Fan1
1Department of Gastrointestinal Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, China.
Introduction:
The optimal medial boundary for lymph node dissection during laparoscopic radical right hemicolectomy for colorectal cancer remains uncertain. We investigated whether the superior mesenteric artery (SMA) or superior mesenteric vein (SMV) should serve as the medial border for D3 lymph node dissection in right hemicolon cancer.
Methods:
We systematically searched the Cochrane Library, EMBASE, CNKI, VIP, Wanfang, ClinicalTrials.gov, and SinoMed databases through March 2024. Studies comparing SMA- and SMV-based medial borders were included according to predefined criteria. Outcomes analyzed included intraoperative parameters, postoperative recovery, lymph node yield, complications, and survival.
Results:
Compared with the SMV group, the SMA group had more lymph nodes cleared (P = 0.001) and more positive nodes retrieved (P = 0.04), but also longer postoperative drain placement (P = 0.01). Intraoperative bleeding was higher in the SMV group (P = 0.01). Meta-analysis of patients' postoperative overall survival (P = 0.927) and recurrence-free survival (P = 0.949) showed no significant differences in short-term prognosis between the two groups.
Discussion:
Using the SMA's left border for laparoscopic D3 dissection is safe and feasible, providing higher lymph node yield without increasing major complications. However, this greater yield did not translate into improved short-term survival. The long-term prognostic effect of the SMA approach requires further investigation.
Systematic Review Registration:
identifier (CRD42024502882).
