The following is a summary of “Extended Right-Sided Colon Resection Does Not Reduce the Risk of Colon Cancer Local-Regional Recurrence: Nationwide Population-Based Study From Danish Colorectal Cancer Group Database,” published in the July 2023 issue of Diseases of the Colon and Rectum by El-Hussuna et al.
The oncological benefits of extensive resection of right-sided colon cancer are controversial. The objective of this study was to assess the short- and long-term outcomes of extended surgical resection of the mesocolon in comparison to the conventional approach. The study is conducted using a prospectively maintained Danish Colorectal Cancer Group database. The primary outcome measures encompassed local-regional recurrence in patients who underwent curative resection for right-sided colon cancer and the presence of postoperative complications within a 30-day timeframe. Distant metastasis, unforeseen intraoperative complications, and mortality rates 30 and 90 days after surgery were also examined. The study did not include patients who underwent palliative or compromised resection, emergency surgery, or neoadjuvant chemotherapy.
Out of the 12,855 individuals who underwent surgery to remove cancer in the right side of their colon, 1,151 patients received an extended right hemicolectomy. The study population consisted of individuals who experienced a comprehensive proper hemicolectomy procedure. These patients were predominantly younger males with lower ASA scores. The surgical intervention was performed by skilled colorectal surgeons utilizing a laparoscopic technique. Notably, a significantly greater quantity of lymph nodes was extracted during the procedure. The incidence of local-regional recurrence was 1.1% (136 out of 12,855 cases), and there was no significant variation observed between conventional right hemicolectomy and extended right hemicolectomy (odds ratio [OR], 1.7; 95% CI, 0.63–2.18). The incidence of postoperative medical complications was notably elevated in patients who underwent extended right hemicolectomy, even after accounting for factors such as age, comorbidity, abdominal access, and other variables (odds ratio [OR], 1.26; 95% CI, 1.01–1.58).
No significant disparity between conventional right hemicolectomy and extended right hemicolectomy regarding distant metastasis rates, unplanned intraoperative adverse events, and mortality was observed. Due to the nature of this register-based study, the possibility of underreporting cannot be ruled out. Extended right hemicolectomy, as delineated in this investigation, does not accurately depict the magnitude of lymphatic dissection executed during the surgical procedure. This extensive population-based register study demonstrated no disparity in local-regional recurrence of right-sided colon cancer between conventional. It extended right hemicolectomy with mesenteric resection and ligation of the middle colic vessels. Extended resection was correlated with elevated incidences of postoperative complications.