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Updated: Jan 7, 2026

The Role of Anatomical Dissection in Defining Colic and Small Bowel Artery Lymphovascular Bundles in the D3 Volume of Small and Large Bowel Mesentery

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

M Škrovina, M Dosoudil, H Hlavíková

Rozhledy V Chirurgii : Mesicnik Ceskoslovenske Chirurgicke Spolecnosti

|January 2, 2026

Summary

Robotic-assisted complete mesocolic excision with modified D3 lymphadenectomy for right-sided colon cancer is safe and effective. This approach increases lymph node retrieval, potentially improving cancer staging, while reducing hospital stay and complications like surgical site infections.

Keywords:

D3 lymphadenectomy complete mesocolic excision robotic right colectomy ¬carcinoma of the right colon

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Area of Science:

Colorectal Surgery
Surgical Oncology
Minimally Invasive Surgery

Background:

Complete mesocolic excision (CME) is a standard for right-sided colon cancer.
The optimal extent of lymphadenectomy (e.g., D2 vs. D3) remains debated.
Modified D3 lymphadenectomy aims to increase lymph node yield for improved staging.

Purpose of the Study:

To evaluate the safety and efficacy of robotic-assisted CME with modified D3 lymphadenectomy.
To compare outcomes with open surgery and standard D2 lymphadenectomy.
To assess oncological and perioperative results in right-sided colon cancer.

Main Methods:

A pilot study comparing 28 patients undergoing robotic-assisted modified D3 lymphadenectomy with 59 patients undergoing open D2 lymphadenectomy.
Patients had carcinoma of the cecum and ascending colon.
Groups were matched for comparable input parameters.

Main Results:

Robotic approach had longer operating time but comparable blood loss.
Significantly higher lymph node retrieval in the robotic D3 group (P=0.002).
Shorter postoperative hospital stay (P=0.011) and fewer surgical site infections (0% vs. 17%) in the robotic group.

Conclusions:

Robotic-assisted CME with modified D3 lymphadenectomy is a safe and feasible approach for right-sided colon cancer.
This technique enhances lymph node retrieval without increasing major perioperative complications.
The method shows potential for improved oncological staging and reduced patient recovery time.