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Cola

laparoscopic left colonic resection

open left colonic resection

Marco Braga, MD

The main goal of this study is to clarify if laparoscopy (LPS) could become the standard approach in patients undergoing left colonic resection.

268 patient candidates to left colonic resection were randomly assigned to LPS (n=134) or open (n=134) approach. Postoperative care protocol was the same in both groups. Trained members of the surgical staff who were not involved in the study registered 30-day postoperative morbidity. Cost-benefit analysis was based on hospital costs. Long-term morbidity, quality of life, and 5-year survival have also been evaluated.

The study design was explained to the potential participants who were asked to sign a written informed consent before randomization.

Eligible patients were randomly allocated to LPS or open surgery. Randomization list was computer generated. Assignments were made by means of sealed sequenced masked envelopes which were opened, before the induction of anesthesia, by a nurse unaware of the trial design.

Laparoscopic Versus Open Left Colonic Resection

Laparoscopic vs. Open Left Colonic Resection: a Randomized Monocentric Trial

Università Vita-Salute San Raffaele

Marco Braga MD

Gastrointestinal Agents

Pancrelipase

Pancreatin

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
Laparoscopic Versus Open Left Colonic Resection	NCT00894725	Colon Cancer Benign Disease	laparoscopic le... open left colon...	18 Years -	Università Vita-Salute San Raffaele
Laparoscopic Versus Open Left Colonic Resection	NCT00894725	Colon Cancer Benign Disease	laparoscopic le... open left colon...	18 Years -	Università Vita-Salute San Raffaele
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

Spots Global Cancer Trial Database for left colon cancer