To validate D2 vs D3 dissection in right hemicolectomy with respect to lymphnode yield and post op. complications

Abstract

Background: In colon cancer, D2 dissection means removal of peri-colic nodes and intermediate nodes and D3 dissection means removal of main lymph nodes at the root of the regional artery. The number of lymph nodes retrieved is an important prognostic variable and is most prominently determined by the scope of nodal dissection
Objectives: To compare D2 vs D3 dissection in right hemicolectomy with respect to lymph node yield and post-op. complications
Participants: 56 patients were studied in two groups.
Study design: Prospective observational study
Methods: All the patients were studied in detail at the colorectal division of the Department of General and Minimal Invasive Surgery, SKIMS over a period of 2 years from June 2018 to May 2020. Group A included 33 patients on whom D2 dissection was performed and Group B included 23 patients on whom D3 dissection was performed. Post-operatively patients were followed and observations were made on basis of early postoperative complications and lymph node yield.
Results: Hypertension was the most common comorbidity in both the study groups followed by type 2 diabetes mellitus and hypothyroidism. Postoperative complications, blood loss, and operative time were found to be statistically insignificant between the two groups. Lymph node yield was found to be statistically significant between the two groups with a mean yield of 14.2 in group D2 and 23.7 in group D3.
Conclusion: Compared with the standard (D2) approach, the introduction of CME (D3) surgical management of colon cancer resulted in a significantly higher lymph node yield. Although both the procedures have almost similar complication rates but D3 dissection is an oncologically superior procedure with no increase in complications provided u have the volume and expertise.