Robotic tumor-specific mesocolic excision with D3 lymph node dissection for descending colon cancer

We present a robotic approach to tumor-specific mesocolic excision with D3 lymph node dissection for descending colon cancer. This technique is based on three established principles: the radical en bloc lymphadenectomy of Japanese D3 lymph node dissection, the fascial plane-oriented sharp dissection of Western complete mesocolic excision, and the tumor-adapted rationale of tumor-specific partial mesorectal excision in rectal cancer. Key procedural elements include dissection along the embryological mesocolic plane, standardized 10-cm proximal and distal margins, en bloc lymphadenectomy of stations 231 (paracolic), 232 (intermediate), and 253 (apical), selective ligation of tumor-feeding arteries such as the left colic artery and sigmoid arteries, and preservation of the inferior mesenteric artery trunk to maintain perfusion to the distal bowel. Robotic assistance enables meticulous vascular control and precise mesocolic plane preservation. Between May 2023 and May 2025, 20 patients underwent this procedure without conversions to open surgery or intraoperative complications. The median age was 57 years (IQR 45-69), and median BMI was 22.6 kg/m² (IQR 19.6-24.6). The median blood loss was 72 mL (IQR 42-150), and median number of harvested lymph nodes was 27 (IQR 19-35), including 5 apical nodes (IQR 2-7). One patient experienced Clavien-Dindo grade IIIa ileus; no anastomotic leaks were observed. The median postoperative hospital stay was 7 days. At the last follow-up (median 19 months), all patients were alive without recurrence. These findings highlight tumor-specific mesocolic excision with D3 lymph node dissection as a safe, reproducible, and technically robust strategy for oncological dissection that may help refine the standard of care for descending colon cancer in the era of robotic surgery.