Right-sided hemicolectomy with complete mesocolic excision and modified D3 lymphadenectomy - a pilot study

Principles of complete mesocolic excision with central vascular ligation were first published by Hohenberger with promising oncological results of right-sided colon carcinoma. Nowadays preserving of mesocolon is a gold standard; however, -there is a lack of definitive answer about the extent of lymphadenectomy. Our modified D3 lymphadenectomy can reach higher count of lymph nodes retrieval, and therefore can lead to upstaging in the patient. Nevertheless, more complex procedure can lead to various perioperative complications.

A total of 28 patients were operated by robotic assisted approach with modified D3 lymphadenectomy in the period 1/2023-12/2024 for carcinoma of the cecum and ascending colon. As a control group, 59 patients were enrolled from the period 1/2020-12/2022 operated by an open approach with standard D2 lymphadenectomy. In each input parameter, both groups were comparable.

An operating time was significantly longer in robotic assisted group (P < 0.001). Blood losses were comparable for both groups. Postoperative hospital stay was lower in robotic assisted group and reached a significant threshold (P = 0.011). The re-trieved lymph node count was significantly higher in the group of modified D3 lymphadenectomy (P = 0.002). There were no surgical site infections in the miniivasive group, while in the open group they reached 17%. The occurrence of paralytic ileus was lower in the robotic assisted group (10 vs. 27.1%; P = 0.146).

The results of this pilot study indicate that complete robotic assisted mesocolic excision with modified D3 lymphadenectomy at right-sided colorectal carcinoma is a safe method, and does not increase the risk of peroperative vascular injuries and postoperative complications, such as paralytic ileus or surgical site infection, which leads to a shorter hospital stay.