Skip to main content
SpringerLink
Log in

The effect of combined head and tail approach during laparoscopic D3 lymph node dissection on pain severity and complications in patients with right colon cancer

  • RESEARCH ARTICLE
  • Published:
Clinical and Translational Oncology Aims and scope Submit manuscript

Abstract

Objective

To examine the impact of a combined craniocaudal approach on pain and complications during laparoscopic D3 lymph node dissection in clients diagnosed with right colon cancer (RCC).

Methods

100 RCC patients were divided into Group A and Group B. Both groups underwent laparoscopic D3 lymph node dissection, with Group A undergoing an intermediate approach and Group B undergoing a combined head and tail approach. Two groups of patients’ perioperative (surgical time, intraoperative blood loss, number of lymph node dissection) indicators, postoperative recovery (postoperative exhaust time, postoperative hospital stay, drainage tube removal time) indicators, perioperative pain level (VAS scores 1, 3, and 5 days following surgery), and incidence of complications (vascular injury, intestinal obstruction, anastomotic bleeding, incision infection), and the therapeutic efficacy [CEA, CA19-9] indicators were compared.

Results

Clients in the B team had substantially shorter operating times and considerably fewer intraoperative hemorrhage than those in the A team. The VAS grades of clients in the B team were considerably lower than those in the A team the day following surgery. Clients in the B team experienced vascular injury at a substantially lower rate than those in the A team. The overall incidence rate of problems did not differ statistically significantly between the A team and the B team. Following therapy, teams A and B’s CEA and CA19-9 levels were considerably lower than those of the same team prior to therapy.

Conclusion

Combined craniocaudal technique can significantly reduce intraoperative bleeding, postoperative pain, and the risk of sequelae from vascular injuries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

Availability of data and material

All data generated or analyzed during this study are included in this. Further enquiries can be directed to the corresponding author.

References

  1. Boeding JRE, Ramphal W, Rijken AM, Crolla RMPH, Verhoef C, Gobardhan PD, et al. A systematic review comparing emergency resection and staged treatment for curable obstructing right-sided colon cancer. Ann Surg Oncol. 2020;28(7):3545–55. https://doi.org/10.1245/s10434-020-09124-y.

    Article  PubMed  Google Scholar 

  2. Cavadas ASR, Gonçalves ER, Pereira CC, Rodrigues JF, Pereira JC. Right colon cancer: the influence of specific location on recurrence and survival. Cancer Treat Res Commun. 2023;36: 100724. https://doi.org/10.1016/j.ctarc.2023.100724.

    Article  PubMed  Google Scholar 

  3. De Simoni O, Barina A, Sommariva A, Tonello M, Gruppo M, Mattara G, et al. Complete mesocolic excision versus conventional hemicolectomy in patients with right colon cancer: a systematic review and meta-analysis. Int J Colorectal Dis. 2020;36(5):881–92. https://doi.org/10.1007/s00384-020-03797-3.

    Article  PubMed  Google Scholar 

  4. Duraes L, Steele SR, Valente M, Lavryk O, Connelly TM, Keßler H. Right colon, left colon, and rectal cancer have different oncologic and quality of life outcomes. Int J Colorectal Dis. 2022;37(4):939–48. https://doi.org/10.1007/s00384-022-04121-x.

    Article  PubMed  Google Scholar 

  5. Efetov S, Tulina I, Kitsenko YE, Kochneva KA, Bondrovskaya AS, Picciariello A, et al. Laparoscopic right hemicolectomy with extended D3 lymph node dissection (caudal to cranial approach) and posterior colpotomy for specimen extraction—a video vignette. Colorectal Dis. 2019;22(2):220–1. https://doi.org/10.1111/codi.14846.

    Article  PubMed  Google Scholar 

  6. Fukuoka H, Fukunaga Y, Nagasaki T, Akiyoshi T, Konishi T, Nagayama S, et al. Lymph node mapping in transverse colon cancer treated using laparoscopic colectomy with D3 lymph node dissection. Dis Colon Rectum. 2022;65(3):340–52. https://doi.org/10.1097/dcr.0000000000002108.

    Article  PubMed  Google Scholar 

  7. Guo J, Du C, Deng S, Huang J, Song J, Li X, et al. Identification and quantification of immune infiltration landscape on therapy and prognosis in left- and right-sided colon cancer. Cancer Immunol Immunother. 2021;71(6):1313–30. https://doi.org/10.1007/s00262-021-03076-2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Hiyoshi Y, Sakamoto T, Mukai T, Nagasaki T, Yamaguchi T, Akiyoshi T, et al. Inferior versus medial approach in laparoscopic colectomy with complete mesocolic excision and D3 lymphadenectomy for right-sided colon cancer: a propensity-score-matched analysis. Colorectal Dis. 2022;25(1):56–65. https://doi.org/10.1111/codi.16327.

    Article  PubMed  Google Scholar 

  9. Hojo D, Kawai K, Murono K, Nozawa H, Hata K, Tanaka T, et al. Establishment of deformable three-dimensional printed models for laparoscopic right hemicolectomy in transverse colon cancer. ANZ J Surg. 2021. https://doi.org/10.1111/ans.16659.

    Article  PubMed  Google Scholar 

  10. Huang X. Laparoscopic segmental colectomy with extensive D3 lymph node dissection: a good choice for right transverse colon cancer. World J Surg Oncol. 2022;20(1):85. https://doi.org/10.1186/s12957-022-02530-4.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Huang X, Xiao Z, Huang Z, Li D. Laparoscopic D3 lymph node dissection with left colic artery and first sigmoid artery preservation in rectal cancer. World J Surg Oncol. 2023. https://doi.org/10.1186/s12957-023-02964-4.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hwang DY, Lee GR, Kim JH, Lee YS. Laparoscopic complete mesocolic excision with D3 lymph node dissection for right colon cancer in elderly patients. Sci Rep. 2020. https://doi.org/10.1038/s41598-020-69617-4.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Jin HY, Ibahim AM, Bae JH, Lee CS, Han S, Lee IK, et al. Initial experience of laparoscopic complete mesocolic excision with D3 lymph node dissection for right colon cancer using Artisential ®, a new laparoscopic articulating instrument. J Minim Access Surg. 2022;18(2):235. https://doi.org/10.4103/jmas.jmas_88_21.

    Article  PubMed  Google Scholar 

  14. Kim J, Baek S, Kwak J, Kim J, Kim SH, Ji WB, et al. Impact of D3 lymph node dissection on upstaging and short-term survival in clinical stage I right-sided colon cancer. Asian J Surg. 2021;44(10):1278–82. https://doi.org/10.1016/j.asjsur.2021.02.011.

    Article  PubMed  Google Scholar 

  15. Kim MC, Park SC. Laparoscopic extended right hemicolectomy with superior-to-inferior dissection: a mentee’s initial experience. J Minim Invasive Surg. 2022;25(4):158–60. https://doi.org/10.7602/jmis.2022.25.4.158.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Lee K, Baek S, Kwak J, Kim J, Kim SH. Bowel function and quality of life after minimally invasive colectomy with D3 lymphadenectomy for right-sided colon adenocarcinoma. World J Gastroenterol. 2020;26(33):4972–82. https://doi.org/10.3748/wjg.v26.i33.4972.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Luo W, Lu T, Xiao Y, Li F, Xu Z, Jia Y. A new medial-to-lateral approach for laparoscopic D3 lymphadenectomy plus complete mesocolic excision (D3 + CME) for right-sided colon cancer. Ann Surg Oncol. 2020;28(6):3256–7. https://doi.org/10.1245/s10434-020-09264-1.

    Article  PubMed  Google Scholar 

  18. Mangone L, Pinto C, Mancuso P, Ottone M, Bisceglia I, Chiaranda G, et al. Colon cancer survival differs from right side to left side and lymph node harvest number matter. BMC Public Health. 2021;21(1):906. https://doi.org/10.1186/s12889-021-10746-4.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Mazzarella G, Muttillo EM, Picardi B, Rossi S, Muttillo IA. Complete mesocolic excision and D3 lymphadenectomy with central vascular ligation in right-sided colon cancer: a systematic review of postoperative outcomes, tumor recurrence and overall survival. Surg Endosc. 2021;35(9):4945–55. https://doi.org/10.1007/s00464-021-08529-4.

    Article  PubMed  Google Scholar 

  20. Nguyen NH, Vu XV, Nguyen VQ, Nguyen H, Du Nguyen H, Luong TH, et al. Bach Mai Procedure for complete mesocolic excision, central vascular ligation, and D3 lymphadenectomy in total laparoscopic right hemicolectomy: a prospective study. World J Surg Oncol. 2023;21(1):140. https://doi.org/10.1186/s12957-023-03026-5.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Rajagopalan A, Centauri S, Antoniou E, Arachchi A, Tay YK, Chouhan H, et al. Right hemicolectomy for colon cancer: does the anastomotic configuration affect short-term outcomes? ANZ J Surg. 2023;93(7–8):1870–6. https://doi.org/10.1111/ans.18523.

    Article  PubMed  Google Scholar 

  22. Sun Y, Yang H, Zhang ZC, Zhou Y, Li P, Zeng Q, et al. Fascial space priority approach for laparoscopic complete mesocolic excision (CME) plus central vascular ligation or extended lymphadenectomy (CVL/D3) in right-sided colon cancer (with video). Tech Coloproctol. 2021;26(4):311–3. https://doi.org/10.1007/s10151-021-02536-2.

    Article  PubMed  Google Scholar 

  23. Tsarkov P, Sergey E, Kitsenko YE, Polina P, Kolesnikova O. Laparoscopic bidirectional D3 lymph node dissection for splenic flexure colon cancer—a video vignette. Colorectal Dis. 2022;24(9):1095. https://doi.org/10.1111/codi.16151.

    Article  PubMed  Google Scholar 

  24. Wang X, Efetov S, Liu Z, Medkova Y, Kitsenko YE, Picciariello A, et al. Transrectal specimen extraction after laparoscopic right hemicolectomy with extended D3 lymph node dissection (anterior medial to lateral approach) – a video vignette. Colorectal Dis. 2020;22(4):471–2. https://doi.org/10.1111/codi.14929.

    Article  CAS  PubMed  Google Scholar 

  25. Wang X, Ni H, Jia W, Wang S, Zhang Y, Zhao P, et al. Value of different anastomoses in laparoscopic radical right hemicolectomy for right -sided colon cancer: retrospective study and literature review. World J Surg Oncol. 2022;20(1):318. https://doi.org/10.1186/s12957-022-02789-7.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Xu L, Su X, He Z, Zhang C, Lu J, Zhang G, et al. Short-term outcomes of complete mesocolic excision versus D2 dissection in patients undergoing laparoscopic colectomy for right colon cancer (RELARC): a randomized, controlled, phase 3, superiority trial. Lancet Oncol. 2021;22(3):391–401. https://doi.org/10.1016/s1470-2045(20)30685-9.

    Article  PubMed  Google Scholar 

  27. Yoshizawa J, Gomi K, Makino A, Hisamune R, Sugenoya S, Shimada K, et al. Laparoscopic Abdominal perineal rectal resection for rectal cancer with a horseshoe kidney using preoperative 3D-CT angiography: a case report. BMC Surg. 2021;21(1):15. https://doi.org/10.1186/s12893-020-01032-y.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Zhou L, Diao D, Ye K, Feng Y, Yi X, Tong W, et al. The medial border of laparoscopic D3 lymphadenectomy for right colon cancer: results from an exploratory pilot study. Dis Colon Rectum. 2021;264(10):1286–96. https://doi.org/10.1097/dcr.0000000000002046.

    Article  Google Scholar 

  29. Zizzo M, Zanelli M, Sanguedolce F, Ruiz CC, Biolchini F, Giunta A. Complete mesocolic excision (CME) and D3-lymphadenectomy (D3) for right-sided colon cancers: a potentially prognostic surgical approach. Surg Today. 2021;51(10):1723–4. https://doi.org/10.1007/s00595-021-02306-5.

    Article  PubMed  Google Scholar 

  30. Бaлaбaн BB, Tsugulya P, Tsarkov P. D3 lymph nodes dissection using lateral-to-medial approach in rectal cancer surgery. Dis Colon Rectum. 2022;65(3):e180–1. https://doi.org/10.1097/dcr.0000000000002253.

    Article  Google Scholar 

Download references

Funding

The authors have not received any funding support.

Author information

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, First Affiliated Hospital of Wannan Medical College, No. 2, Zheshan West Road, Jinghu District, Wuhu, 241000, Anhui, China

    Liang Wang, Jun Zhao, Lianghui Shi, Bing Wang & Xiaofeng Zhang

Authors
  1. Liang Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jun Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lianghui Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bing Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xiaofeng Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xiaofeng Zhang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval and consent to participate

The study was approved by the First Affiliated Hospital of Wannan Medical College. Written informed consent was obtained from all individuals included in this study. The hospital ethics committee gave its approval to all experimental procedures.

Consent for publication

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, L., Zhao, J., Shi, L. et al. The effect of combined head and tail approach during laparoscopic D3 lymph node dissection on pain severity and complications in patients with right colon cancer. Clin Transl Oncol (2024). https://doi.org/10.1007/s12094-024-03585-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12094-024-03585-3

Keywords

Search

Navigation