Laparoscopic right hemicolectomy: a SICE (Società Italiana di Chirurgia Endoscopica e Nuove tecnologie) network prospective study on the approach to right colon lymphadenectomy in Italy: is there a standard?-CoDIG 2 (ColonDx Italian Group).
CME
Ileocolic anastomosis
Laparoscopy
Lymphadenectomy
Outcomes
Right hemicolectomy
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
08 Jan 2024
08 Jan 2024
Historique:
received:
29
08
2023
accepted:
17
11
2023
medline:
9
1
2024
pubmed:
9
1
2024
entrez:
9
1
2024
Statut:
aheadofprint
Résumé
Colon cancer is a disease with a worldwide spread. Surgery is the best option for the treatment of advanced colon cancer, but some aspects are still debated, such as the extent of lymphadenectomy. In Japanese guidelines, the gold standard was D3 dissection to remove the central lymph nodes (203, 213, and 223), but in 2009, Hoenberger et al. introduced the concept of complete mesocolic excision, in which surgical dissection follows the embryological planes to remove the mesentery entirely to prevent leakage of cancer cells and collect more lymph nodes. Our study describes how lymphadenectomy is currently performed in major Italian centers with an unclear indication on the type of lymphadenectomy that should be performed during right hemicolectomy (RH). CoDIG 2 is an observational multicenter national study that involves 76 Italian general surgery wards highly specialized in colorectal surgery. Each center was asked not to modify their usual surgical and clinical practices. The aim of the study was to assess the preference of Italian surgeons on the type of lymphadenectomy to perform during RH and the rise of any new trends or modifications in habits compared to the findings of the CoDIG 1 study conducted 4 years ago. A total of 788 patients were enrolled. The most commonly used surgical technique was laparoscopic (82.1%) with intracorporeal (73.4%), side-to-side (98.7%), or isoperistaltic (96.0%) anastomosis. The lymph nodes at the origin of the vessels were harvested in an inferior number of cases (203, 213, and 223: 42.4%, 31.1%, and 20.3%, respectively). A comparison between CoDIG 1 and CoDIG 2 showed a stable trend in surgical techniques and complications, with an increase in the robotic approach (7.7% vs. 12.3%). This analysis shows how lymphadenectomy is performed in Italy to achieve oncological outcomes in RH, although the technique to achieve a higher lymph node count has not yet been standardized. Trial registration (ClinicalTrials.gov) ID: NCT05943951.
Sections du résumé
BACKGROUND
BACKGROUND
Colon cancer is a disease with a worldwide spread. Surgery is the best option for the treatment of advanced colon cancer, but some aspects are still debated, such as the extent of lymphadenectomy. In Japanese guidelines, the gold standard was D3 dissection to remove the central lymph nodes (203, 213, and 223), but in 2009, Hoenberger et al. introduced the concept of complete mesocolic excision, in which surgical dissection follows the embryological planes to remove the mesentery entirely to prevent leakage of cancer cells and collect more lymph nodes. Our study describes how lymphadenectomy is currently performed in major Italian centers with an unclear indication on the type of lymphadenectomy that should be performed during right hemicolectomy (RH).
METHODS
METHODS
CoDIG 2 is an observational multicenter national study that involves 76 Italian general surgery wards highly specialized in colorectal surgery. Each center was asked not to modify their usual surgical and clinical practices. The aim of the study was to assess the preference of Italian surgeons on the type of lymphadenectomy to perform during RH and the rise of any new trends or modifications in habits compared to the findings of the CoDIG 1 study conducted 4 years ago.
RESULTS
RESULTS
A total of 788 patients were enrolled. The most commonly used surgical technique was laparoscopic (82.1%) with intracorporeal (73.4%), side-to-side (98.7%), or isoperistaltic (96.0%) anastomosis. The lymph nodes at the origin of the vessels were harvested in an inferior number of cases (203, 213, and 223: 42.4%, 31.1%, and 20.3%, respectively). A comparison between CoDIG 1 and CoDIG 2 showed a stable trend in surgical techniques and complications, with an increase in the robotic approach (7.7% vs. 12.3%).
CONCLUSIONS
CONCLUSIONS
This analysis shows how lymphadenectomy is performed in Italy to achieve oncological outcomes in RH, although the technique to achieve a higher lymph node count has not yet been standardized. Trial registration (ClinicalTrials.gov) ID: NCT05943951.
Identifiants
pubmed: 38191814
doi: 10.1007/s00464-023-10607-8
pii: 10.1007/s00464-023-10607-8
doi:
Banques de données
ClinicalTrials.gov
['NCT05943951']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Investigateurs
V Adamo
(V)
M Ammendola
(M)
P Angelini
(P)
M Annecchiarico
(M)
G Aprea
(G)
F Autori
(F)
G Baldazzi
(G)
A Balla
(A)
G Baronio
(G)
G Bellio
(G)
G Bertelli
(G)
C Bima
(C)
L D Bonomo
(LD)
D Borreca
(D)
E Botteri
(E)
A Brescia
(A)
L Cafagna
(L)
P Capelli
(P)
V Caracino
(V)
M Caricato
(M)
M Carlini
(M)
E Cassinotti
(E)
M Catarci
(M)
P Chiaro
(P)
N Cillara
(N)
M Clementi
(M)
R B Contul
(RB)
G Curro
(G)
N De Manzini
(N)
M Degiuli
(M)
D Delogu
(D)
A Di Leo
(A)
U Elmore
(U)
G Ercolani
(G)
F Festa
(F)
R Galleano
(R)
G Gambino
(G)
R Gelmini
(R)
A Giordano
(A)
R La Mendola
(R)
L Laface
(L)
L Masoni
(L)
A Maurizi
(A)
R Memeo
(R)
P Mercantini
(P)
G Merola
(G)
M Milone
(M)
M Montuori
(M)
L Morelli
(L)
I A Muttillo
(IA)
R Nascimbeni
(R)
T Nelli
(T)
S Olmi
(S)
M Ortenzi
(M)
A Patriti
(A)
G Pavone
(G)
M Pisano
(M)
R Polastri
(R)
D Rega
(D)
M Rottoli
(M)
E Saladino
(E)
M Santarelli
(M)
R Santoro
(R)
A Sartori
(A)
M Scatizzi
(M)
G Sica
(G)
W Siquini
(W)
M Sorrentino
(M)
F Staderini
(F)
L Vincentini
(L)
G Aizza
(G)
M Ammendola
(M)
P Amodio
(P)
F Aquilino
(F)
G Argenio
(G)
A Avanzolini
(A)
L Baldari
(L)
F Banchini
(F)
M Benedetti
(M)
V Bertino
(V)
A Bianco
(A)
F Blasi
(F)
L Bonariol
(L)
D Bono
(D)
A Bottari
(A)
S Buscemi
(S)
G Calini
(G)
R Campagnacci
(R)
S Cantafio
(S)
G T Capolupo
(GT)
M Capuano
(M)
F Carannante
(F)
M Casati
(M)
D Cassini
(D)
S Castiglioni
(S)
C Cecconi
(C)
L Cestino
(L)
N Chetta
(N)
F M Chiappetta
(FM)
L Cinelli
(L)
A Cojutti
(A)
D Colettta
(D)
D Corallino
(D)
L Crepaz
(L)
S Curcio
(S)
G Cuticone
(G)
F D'Agostino
(F)
M De Luca
(M)
G D De Palma
(GD)
C De Rosa
(C)
A De Serra
(A)
R Del Giudice
(R)
G Di Franco
(G)
F Foglio
(F)
G Fontani
(G)
L Fortuna
(L)
M R Fortunato
(MR)
D Frazzini
(D)
N Furbetta
(N)
E Gambino
(E)
I Garosio
(I)
P Germani
(P)
O Ghazouani
(O)
D Giannotti
(D)
E Gibin
(E)
A Grasso
(A)
M Grieco
(M)
D Izzo
(D)
G G Laracca
(GG)
G Lauteri
(G)
P Lepiane
(P)
F S Li Causi
(FS)
E Locci
(E)
G Lorenzo
(G)
A Madaro
(A)
F Madeddu
(F)
F Maggi
(F)
F Maiello
(F)
M Manigrasso
(M)
R Marcellinaro
(R)
P Marinello
(P)
M S Mattei
(MS)
G Mazzarella
(G)
G Merola
(G)
F Moroni
(F)
A Murgese
(A)
E M Muttillo
(EM)
A Oldani
(A)
M Paicilli
(M)
M Palmieri
(M)
G Palomba
(G)
G Paolini
(G)
D Parini
(D)
G M Paroli
(GM)
M Pellicciaro
(M)
N Petrucciani
(N)
B Picardi
(B)
R Piccolo
(R)
E Pinotti
(E)
A Pisanu
(A)
R Reddavid
(R)
A Resendiz
(A)
G Romano
(G)
E G Rossi
(EG)
R Saracco
(R)
R Scaramuzzo
(R)
F Serra
(F)
E Sgotto
(E)
L Solaini
(L)
M Spalluto
(M)
L Taglietti
(L)
E Tartaglia
(E)
N Tartaglia
(N)
B Torre
(B)
R Tutino
(R)
M Varesano
(M)
N Vettoretto
(N)
E Villamaina
(E)
T Viora
(T)
M Yusef
(M)
M Zago
(M)
A Zerbinati
(A)
Informations de copyright
© 2024. The Author(s).
Références
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424
doi: 10.3322/caac.21492
pubmed: 30207593
Xu L, Su X, He Z, Zhang C, Lu J, Zhang G, Sun Y, Du X, Chi P, Wang Z, Zhong M, Wu A, Zhu A, Li F, Xu J, Kang L, Suo J, Deng H, Ye Y, Ding K, Xu T, Zhang Z, Zheng M, Xiao Y, RELARC Study Group (2021) Short-term outcomes of complete mesocolic excision versus D2 dissection in patients undergoing laparoscopic colectomy for right colon cancer (RELARC): a randomised, controlled, phase 3, superiority trial. Lancet Oncol 22(3):391–401. https://doi.org/10.1016/S1470-2045(20)30685-9
doi: 10.1016/S1470-2045(20)30685-9
pubmed: 33587893
Sica GS, Vinci D, Siragusa L, Sensi B, Guida AM, Bellato V, García-Granero Á, Pellino G (2023) Definition and reporting of lymphadenectomy and complete mesocolic excision for radical right colectomy: a systematic review. Surg Endosc 37(2):846–861. https://doi.org/10.1007/s00464-022-09548-5
doi: 10.1007/s00464-022-09548-5
pubmed: 36097099
Guillou PJ, Quirke P, Thorpe H et al (2005) Shortterm endpoints of conventional versus laparoscopicassisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. The Lancet 365:1718–1726
doi: 10.1016/S0140-6736(05)66545-2
Dennosuke J (1983) General rules for clinical and pathological studies on cancer of the colon, rectum and anus. Part I. Clinical classification. Jpn J Surg 13:557–573
doi: 10.1007/BF02469505
Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation—technical notes and outcome. Colorectal Dis 11:354–364 (discussion 364–365)
doi: 10.1111/j.1463-1318.2008.01735.x
pubmed: 19016817
Degiuli M, Solej M, Resendiz Aguilar HA, Marchiori G, Reddavid R (2022) Complete mesocolic excision in comparison with conventional surgery for right colon cancer: a nationwide multicenter study of the Italian Society of Surgical Oncology colorectal cancer network (CoME-in trial). Study protocol for a randomized controlled trial. Jpn J Clin Oncol 52(10):1232–1241. https://doi.org/10.1093/jjco/hyac116
doi: 10.1093/jjco/hyac116
pubmed: 35849819
Anania G, Davies RJ, Bagolini F, Vettoretto N, Randolph J, Cirocchi R, Donini A (2021) Right hemicolectomy with complete mesocolic excision is safe, leads to an increased lymph node yield and to increased survival: results of a systematic review and meta-analysis. Tech Coloproctol 25(10):1099–1113. https://doi.org/10.1007/s10151-021-02471-2
doi: 10.1007/s10151-021-02471-2
pubmed: 34120270
pmcid: 8419145
West NP, Morris EJA, Rotimi O, Cairns A, Finan PJ, Quirke P (2008) Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study. Lancet Oncol 9:857–865
doi: 10.1016/S1470-2045(08)70181-5
pubmed: 18667357
Kim NK, Kim YW, Han YD, Cho MS, Hur H, Min BS et al (2016) Complete mesocolic excision and central vascular ligation for colon cancer: principle, anatomy, surgical technique, and outcomes. Surg Oncol 25(3):252–262
doi: 10.1016/j.suronc.2016.05.009
pubmed: 27566031
Tejedor P, Francis N, Jayne D, Hohenberger W, Khan J, on behalf the CME Project Working Group (2022) Consensus statements on complete mesocolic excision for right-sided colon cancer-technical steps and training implications. Surg Endosc 36(8):5595–5601. https://doi.org/10.1007/s00464-021-08395-0
doi: 10.1007/s00464-021-08395-0
pubmed: 35790593
pmcid: 9283340
Anania G, Agresta F, Artioli E, Rubino S, Resta G, Vettoretto N, Petz WL, Bergamini C, Arezzo A, Valpiani G, Morotti C, Silecchia G, SICE CoDIG (Colon Dx Italian Group) (2020) Laparoscopic right hemicolectomy: the SICE (Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie) network prospective trial on 1225 cases comparing intra corporeal versus extra corporeal ileo-colic side-to-side anastomosis. Surg Endosc 34(11):4788–4800. https://doi.org/10.1007/s00464-019-07255-2 ; Erratum in: Surg Endosc 2019
doi: 10.1007/s00464-019-07255-2
pubmed: 31741153
Balciscueta Z, Balciscueta I, Uribe N, Pellino G, Frasson M, García-Granero E, García-Granero Á (2021) D3-lymphadenectomy enhances oncological clearance in patients with right colon cancer. Results of a meta-analysis. Eur J Surg Oncol 47(7):1541–1551. https://doi.org/10.1016/j.ejso.2021.02.020
doi: 10.1016/j.ejso.2021.02.020
pubmed: 33676793
Son GM, Lee IY, Lee YS, Kye BH, Cho HM, Jang JH, Kim CN, Lee KY, Lee SH, Kim JG, Korean Laparoscopic Colorectal Surgery Study Group (2021) Is laparoscopic complete mesocolic excision and central vascular ligation really necessary for all patients with right-sided colon cancer? Ann Coloproctol 37(6):434–444. https://doi.org/10.3393/ac.2021.00955.0136
doi: 10.3393/ac.2021.00955.0136
pubmed: 34875818
pmcid: 8717068
Ueno H, Hase K, Shiomi A, Shiozawa M, Ito M, Sato T, Hashiguchi Y, Kusumi T, Kinugasa Y, Ike H, Matsuda K, Yamada K, Komori K, Takahashi K, Kanemitsu Y, Ozawa H, Ohue M, Masaki T, Takii Y, Ishibe A, Watanabe J, Toiyama Y, Sonoda H, Koda K, Akagi Y, Itabashi M, Nakamura T, Sugihara K (2023) Optimal bowel resection margin in colon cancer surgery: prospective multicentre cohort study with lymph node and feeding artery mapping. Lancet Reg Health West Pac 33:100680. https://doi.org/10.1016/j.lanwpc.2022.100680
doi: 10.1016/j.lanwpc.2022.100680
pubmed: 37181532
pmcid: 10166781
Benz S, Tannapfel A, Tam Y, Grünenwald A, Vollmer S, Stricker I (2019) Proposal of a new classification system for complete mesocolic excison in right-sided colon cancer. Tech Coloproctol 23(3):251–257. https://doi.org/10.1007/s10151-019-01949-4
doi: 10.1007/s10151-019-01949-4
pubmed: 30838463
Kotake K, Honjo S, Sugihara K, Hashiguchi Y, Kato T, Kodaira S et al (2012) Number of lymph nodes retrieved is an important determinant of survival of patients with stage II and stage III colorectal cancer. Jpn J Clin Oncol 42(1):29–35
doi: 10.1093/jjco/hyr164
pubmed: 22102737
Smalbroek BP, Smits AB, Khan JS (2023) Safe oncological and standardised (“SOS”) right hemicolectomy for colon cancer. Tech Coloproctol 27(3):169–170. https://doi.org/10.1007/s10151-022-02749-z
doi: 10.1007/s10151-022-02749-z
pubmed: 36645583
Xu L, Su X, He Z, Zhang C, Lu J, Zhang G et al (2021) Short-term outcomes of complete mesocolic excision versus D2 dissection in patients undergoing laparoscopic colectomy for right colon cancer (RELARC): a randomised, controlled, phase 3, superiority trial. Lancet Oncol 22(3):391–401
doi: 10.1016/S1470-2045(20)30685-9
pubmed: 33587893
Crane J, Hamed M, Borucki JP, El-Hadi A, Shaikh I, Stearns AT (2021) Complete mesocolic excision versus conventional surgery for colon cancer: a systematic review and meta-analysis. Color Dis 23(7):1670–1686
doi: 10.1111/codi.15644
Hida J, Yasutomi M, Maruyama T, Fujimoto K, Uchida T, Okuno K (1997) The extent of lymph node dissection for colon carcinoma: the potential impact on laparoscopic surgery. Cancer 80(2):188–192
doi: 10.1002/(SICI)1097-0142(19970715)80:2<188::AID-CNCR3>3.0.CO;2-Q
pubmed: 9217028