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the group underwent laparoscopic right hemicolectomy with CME. In complete mesocolic excision group (CME), the dissecting extent includes the lymphatic and fat tissues surrounding the root of ascending mesocolon, which situated on the surface of superior mesenteric vein, and the root of right half of transverse mesocolon, which situated on the surface of pancreas neck.

the group underwent laparoscopic right hemicolectomy with D3 lymph node dissection. In D3 lymph node dissection group(D3), the lymph node dissection is based on ligating the supplying vessels close to the right-side of superior mesenteric vein and clean up the surrounding lymph node and adipose tissue. No.6 lymph node should be dissected in this group.

the group underwent laparoscopic right hemicolectomy with CME. In CME group, in addition to D2 dissection, the whole mesocolon, from ascending colon to right half transverse colon, as well as the central lymph nodes should be entirely removed.

Intervention: Procedure: Complete mesocolic excision (CME)

the group underwent laparoscopic right hemicolectomy with D3 lymph node dissection. In D3 group, the mesocolon should be removed and the dissection involves the paracolon and intermediate lymph nodes,including No.6 lymph node, which along the feeding vessels.

Intervention: Procedure: D3 radical operation

Minhua Zheng, PhD

Hiju Hong, PhD Student

To standardize the surgery for advanced right hemi colon cancer with laparoscopy and investigate whether extended lymphadenectomy (CME) could improve disease-free survival in patients with right colon cancer, compared with D3 radical operation in laparoscopic colectomy.

Standardization of Laparoscopic Surgery for Right Hemi Colon Cancer (SLRC)

Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine

RenJi Hospital

Xinhua Hospital, Shanghai Jiao Tong University School of Medicine

Fudan University

Ruijin Hospital

professor

For tumours in splenic flexure and proximal and mid part of descending colon lymph nodes 232 and 231 will be removed.

For tumours in distal part of descending colon and proximal sigmoid lymph nodes 231, 232 and partially 241, 242 (considering variation of the feeding artery) will be removed.

For tumours in the mid part of sigmoid colon lymph nodes 241, 242 will be removed.

For tumours in the rectosigmoid junction 251, 252 groups of the lymph node will be removed.

For tumours in splenic flexure and proximal and mid part of descending colon lymph nodes 232, 231 and 253 will be removed.

For tumours in distal part of descending colon and proximal sigmoid lymph nodes 231, 232 and 253 and partially 241, 242 (considering variation of the feeding artery) will be removed.

For tumours in the mid part of sigmoid colon lymph nodes 241, 242 and 253 will be removed.

For tumours in the rectosigmoid junction 251, 252 and 253 groups of the lymph node will be removed.

This procedure is performed for tumours in splenic flexure and proximal and descending colon.

Left colic artery is divided at its origin. Sigmoid arteries and superior rectal arteries are preserved. Inferior mesenteric vein is divided at the lower border of the pancreas. The colon is divided about 10 cm proximal and distal to the tumour. Mesocolic fascia is preserved and the length of the "vessel trunk" of the mesocolon corresponds to the level of lymph node dissection. After removal of the resected colonic segment a handsewn or stapler end-to-end or side-to-side colonic anastomosis is performed.

Left colon resection

This procedure is performed for tumours in sigmoid colon. Corresponding sigmoid arteries are divided at their origin. Left colic artery and superior rectal artery are preserved. Inferior mesenteric vein is divide close to the left colic artery. Proximal and distal margin compose 10 cm from the tumour. Mesocolic fascia is preserved and the length of the "vessel trunk" of the mesocolon corresponds to the level of lymph nodes dissection. After removal of the resected colonic segment a handsewn end-to-end or side-to-side or stapler colonic anastomosis is performed.

Sigmoid colon resection

This procedure is performed for tumours in distal sigmoid colon or rectosigmoid junction. Superior rectal artery is divided below the origin of left colic artery. Left colic artery is preserved. Inferior mesenteric vein is divide close to the left colic artery. The colon is divided about 10 cm proximal and 5 cm distal to the tumour. Mesocolic fascia is preserved and the length of the "vessel trunk" of the mesocolon corresponds to the level of lymph node dissection. After removal of the resected colonic segment handsewn or stapler colo-rectal anastomosis is performed.

Distal sigmoid colon resection or anterior resection

Vladimir Balaban, Ph.D

Inna Tulina, Ph.D

Mihail Mutyk

Peter Tsarkov, Ph.D

The efficiency of the D3 lymph node dissection is still controversial for left colon cancer patients. This study will try find difference in 5-year overall survival between D2 and D3 lymph node dissection. Investigation of the functional and short-term outcomes will clarify safety of the D3 lymph node dissection.

Discussion about optimal type of lymph node dissection in colorectal cancer continues during last 15 years, when in Europe was presented concept of complete mesocolic excision. However, this concepts is very close to Japanese D3 lymph node dissection and in the first view it seems the same but principal differences were found. Japanese concept is partial resection of the bowel according feeding artery (short bowel specimen, long lymphovascular pedicle), opposite European concept is wide resection of the bowel like hemicolectomy or extended hemicolectomy, sigmoidectomy. In complete mesocolic excision anatomical landmarks are still unclear but in Japanese guidelines it has anatomical margins which can standardize this procedure. Also nerve sparing technique around root of inferior mesenteric artery was described. One more difference is in histological examination of the specimen. European concept is to pay more attention to the quality of complete mesocolic excision and less - to the number of investigated lymph nodes. In Japan lymph node extraction is performed by surgical team from the fresh specimen and send to pathologist separately (each group of lymph nodes). Considering the absence of randomized control trials for patients with left colon cancer DILEMMA trial was started using Japanese approach

D2 vs D3 Lymph Node Dissection for Left Colon Cancer

D2 vs D3 Lymph Node Dissection for Left Colon Cancer: Multicenter Randomize Control Trial (DILEMMA)

Probability to be alive measured in %, where 100% means that patients have a 100% probability to be alive and 0% means that patients have 0% probability to be alive

Probability to be alive with no signs of local or distant recurrence measured in %, where 100% means that patients have a 100% probability to be alive with no signs of local or distant recurrence and 0% means that patients have 0% probability to be alive with no signs of local or distant recurrence

The rate of ejaculation problems in sexually active men and the rate of decreased vaginal lubricant production in sexually active women, measured in % from the total number of male/female patients

The rate of lymph nodes 253 with metastatic cells among all lymph nodes 253, measured in %

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Standardization of Laparoscopic Surgery for Right Hemi Colon Cancer (SLRC)	NCT02942238	Overall Surviva... Postoperative C... Metastasis Stage, Colon Ca...	CME D3	18 Years - 75 Years	Ruijin Hospital
D2 vs D3 Lymph Node Dissection for Left Colon Cancer	NCT04364373	Colon Cancer	Left colon rese... Sigmoid colon r... Distal sigmoid ...	18 Years - 75 Years	Russian Society of Colorectal Surgeons
Standardization of Laparoscopic Surgery for Right Hemi Colon Cancer (SLRC)	NCT02942238	Overall Surviva... Postoperative C... Metastasis Stage, Colon Ca...	CME D3	18 Years - 75 Years	Ruijin Hospital

Spots Global Cancer Trial Database for d3

Every month we try and update this database with for d3 cancer trials from around the world to help patients and their families find trials that might be right for them.
We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.

Spots Global Cancer Trial Database for d3

Every month we try and update this database with for d3 cancer trials from around the world to help patients and their families find trials that might be right for them. We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.

Every month we try and update this database with for d3 cancer trials from around the world to help patients and their families find trials that might be right for them.
We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.