Authors:
M. Škrovina 1,2; M. Dosoudil 1; H. Hlavíková 1; E. Holášková 1; M. Badlíková 1; J. Bartoš 1; P. Anděl 1; L. Přibylová 3; A. Ferko 1
Authors‘ workplace:
Chirurgické oddělení, Nemocnice AGEL Nový Jičín a. s.
1; Chirurgická klinika LF UP a FN Olomouc
2; Katedra aplikované matematiky, FEI, VŠB – TU Ostrava
3
Published in:
Rozhl. Chir., 2025, roč. 104, č. 11, s. 495-503.
Category:
Original articles
doi:
https://doi.org/10.48095/ccrvch2025495
Overview
Introduction: 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.
Methods: 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.
Results: 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 retrieved 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).
Conclusion: 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.
Keywords:
robotic right colectomy – complete mesocolic excision – D3 lymphadenectomy – ¬carcinoma of the right colon
Sources
1. Brown KG, Ng KS, Solomon MJ et al. Complete mesocolic excision for colon cancer: current status and controversies. ANZ J Surg 2024; 94(3): 309–319. doi: 10.1111/ans.18741.
2. Killeen S, Mannion M, Devaney A et al. Complete mesocolic resection and extended lymphadenectomy for colon cancer: a systematic review. Colorectal Dis 2014; 16(8): 577–594. doi: 10.1111/codi.12616.
3. Hohenberger W, Weber K, Matzel K et al. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation – technical notes and outcome. Colorectal Dis 2009; 11(4): 354–365. doi: 10.1111/j.1463-1318.2008.01735.x.
4. Khan JS, Ahmad A, Odermatt M et al. Robotic complete mesocolic excision with central vascular ligation for right colonic tumours – a propensity score-matching study comparing with standard laparoscopy. BJS Open 2021; 5(2): zrab016. doi: 10.1093/bjsopen/zrab016.
5. Kobayashi H, West NP, Takahashi K et al. Quality of surgery for stage III colon cancer: comparison between England, Germany, and Japan. Ann Surg Oncol 2014; 21 Suppl 3: S398–S404. doi: 10.1245/s10434-014-3578-9.
6. Procházka V, Zetelová A, Grolich T et al. Kompletní mezokolická excize u pravostranné hemikolektomie. Rozhl Chir 2016; 95(10): 359–364.
7. Koh FH, Tan KK. Complete mesocolic excision for colon cancer: is it worth it? J Gastrointest Oncol 2019; 10(6): 1215–1221. doi: 10.21037/jgo.2019.05.01.
8. Mathew R, Kim SH. Robotic right hemicolectomy with D3 lymphadenectomy and complete mesocolic excision: technical detail. OA Robotic Surgery 2013; 1(1): 6.
9. Balciscueta Z, Balciscueta I, Uribe N et al. D3-lymphadenectomy enhances oncological clearance in patients with right colon cancer. Results of a meta-analysis. Eur J Surg Oncol 2021; 47(7): 1541–1551. doi: 10.1016/j.ejso.2021.02.020.
10. Hashiguchi Y, Muro K, Saito Y et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol 2020; 25(1): 1–42. doi: 10.1007/s10147-019-01485-z.
11. Vogel JD, Felder SI, Bhama AR et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of colon cancer. Dis Colon Rectum 2022; 65(2): 148–177. doi: 10.1097/DCR.0000000000002323.
12. Emmanuel A, Haji A. Complete mesocolic excision and extended (D3) lymphadenectomy for colonic cancer: is it worth that extra effort? A review of the literature. Int J Colorectal Dis 2016; 31(4): 797–804. doi: 10.1007/s00384-016-2502-0.
13. Spasojevic M, Stimec BV, Dyrbekk AP et al. Lymph node distribution in the d3 area of the right mesocolon: implications for an anatomically correct cancer resection. A postmortem study. Dis Colon Rectum 2013; 56(12): 1381–1387. doi: 10.1097/01.dcr.0000436279.18577.d3.
14. Kawada H, Kurita N, Nakamura F et al. Incorporation of apical lymph node status into the seventh edition of the TNM classification improves prediction of prognosis in stage III colonic cancer. Br J Surg 2014; 101(9): 1143–1152. doi: 10.1002/bjs.9548.
15. R Core Team R, a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. 2025 [online]. Dostupné z: https://www.R-project.org.
16. Bokey EL, Ojerskog B, Chapuis PH et al. Local recurrence after curative excision of the rectum for cancer without adjuvant therapy: role of total anatomical dissection. Br J Surg 1999; 86(9): 1164–1170. doi: 10.1046/j.1365-2168.1999.01216.x.
17. Peltrini R, Luglio G, Pagano G et al. Gastrocolic trunk of Henle and its variants: review of the literature and clinical relevance in colectomy for right-sided colon cancer. Surg Radiol Anat 2019; 41(8): 879–887. doi: 10.1007/s00276-019-02253-4.
18. Gouvas N, Pechlivanides G, Zervakis N et al. Complete mesocolic excision in colon cancer surgery: a comparison between open and laparoscopic approach. Colorectal Dis 2012; 14(11): 1357–1364. doi: 10.1111/j.1463-1318.2012.03019.x.
19. Di Buono G, Buscemi S, Cocorullo G et al. Feasibility and safety of laparoscopic Complete Mesocolic Excision (CME) for right-sided colon cancer: short-term outcomes. A randomized clinical study. Ann Surg 2021; 274(1): 57–62. doi: 10.1097/SLA.0000000000004557.
20. Martínek L, Škrovina M, Bergamaschi R. Right hemicolectomy – from laparoscopic facilitated technique to robotic intracorporeal anastomosis. Rozhl Chir 2020; 99(3): 110–115. doi: 10.33699/PIS.2020.99.3.110-115.
21. Thorsen Y, Stimec B, Andersen SN et al. Bowel function and quality of life after superior mesenteric nerve plexus transection in right colectomy with D3 extended mesenterectomy. Tech Coloproctol 2016; 20(7): 445–453. doi: 10.1007/s10151-016-1466-y.
22. Hedrick TL, McEvoy MD, Mythen MG et al. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Gastrointestinal Dysfunction within an enhanced recovery pathway for elective colorectal surgery. Anesth Analg 2018; 126(6): 1896–1907. doi: 10.1213/ANE.0000000000002742.
23. Lovay K, Barla J, Vaško J et al. Laparoscopic versus open elective right hemicolectomy with curative intent for colon adenocarcinoma. Rozhl Chir 2022; 100(12): 584–591. doi: 10.33699/PIS.2021.100.12.584-591.
24. Benčurik V, Škrovina M, Martínek L et al. Intraoperative fluorescence angiography and risk factors of anastomotic leakage in mini-invasive low rectal resections. Surg Endosc 2021; 35(9): 5015–5023. doi: 10.1007/s00464-020-07982-x.
25. Degiuli M, Aguilar AH, Solej M et al. A randomized phase III trial of complete mesocolic excision compared with conventional surgery for right colon cancer: interim analysis of a nationwide multicenter study of the Italian Society of Surgical Oncology Colorectal Cancer Network (CoME-in trial). Ann Surg Oncol 2024; 31(3): 1671–1680. doi: 10.1245/s10434-023-14664-0.
26. Van Eetvelde E, Duhoky R, Piozzi GN et al. European multicentre analysis of the implementation of robotic complete mesocolic excision for right-sided colon tumours. Colorectal Dis 2025; 27(1): e17287. doi: 10.1111/codi.17287.
27. Aghayeva A, Seker ME, Bayrakceken S et al. Comparison of postoperative outcomes and long-term survival rates between patients who underwent robotic and laparoscopic complete mesocolic excision for right-sided colon cancer. J Laparoendosc Adv Surg Tech A 2024; 34(10): 890–897. doi: 10.1089/lap.2024.0144.
28. Struys M, Ceelen W. Incidence of lymph node recurrence after primary surgery for non-metastatic colon cancer: a systematic review. Eur J Surg Oncol 2022; 48(8): 1679–1684. doi: 10.1016/j.ejso.2022.04.019.
29. Ow ZG, Sim W, Nistala KR et al. Comparing complete mesocolic excision versus conventional colectomy for colon cancer: a systematic review and meta-analysis. Eur J Surg Oncol 2021; 47(4): 732–737. doi: 10.1016/j.ejso.2020.09.007.
30. Wang C, Gao Z, Shen K et al. Safety, quality and effect of complete mesocolic excision vs non-complete mesocolic excision in patients with colon cancer: a systemic review and meta-analysis. Colorectal Dis 2017; 19(11): 962–972. doi: 10.1111/codi.13900.
31. Mazzarella G, Muttillo EM, Picardi B et al. 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): 4945–4955. doi: 10.1007/s00464-021-08529-4.
32. Crane J, Hamed M, Borucki JP et al. Complete mesocolic excision versus conventional surgery for colon cancer: a systematic review and meta-analysis. Colorectal Dis 2021; 23(7): 1670–1686. doi: 10.1111/codi.15644.
33. De Lange G, Davies J, Toso C et al. Complete mesocolic excision for right hemicolectomy: an updated systematic review and meta-analysis. Tech Coloproctol 2023; 27(11): 979–993. doi: 10.1007/s10151-023-02853-8.
