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Pancrelipase

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Cola

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 %

The rate of any complications within the course of surgery

The rate of surgical and infectious complications

I.M. Sechenov First Moscow State Medical University

G.V. Bondar Republican Cancer Center

Russian Society of Colorectal Surgeons

Symptoms and General Pathology

Recurrence

Adenocarcinoma

Postoperative Complications

Anastomotic Leak

Rectal Neoplasms

Rectal Diseases

Carcinoma

Neoplasms, Glandular and Epithelial

Neoplasms by Histologic Type

Tumors located anywhere from the cecum to the proximal transverse colon.

Tumors located anywhere from the distal transverse colon to the rectosigmoid junction

Tumors located in rectosigmoid junction and in the rectum with/without the external sphincter or the levator muscles invasion

Patients with primary multiple cancer tumors

Resection of the caecum and ascending colon is appropriate for patients with tumors located anywhere from caecum to the transverse colon

Right hemicolectomy

Resection of the sigmoid colon is appropriate for patients with tumors located anywhere from the distal transverse colon to the rectosigmoid junction.

Left hemicolectomy

Resection of the sigmoid colon is appropriate for patients with tumors located in the sigmoid colon

AR is appropriate for tumors located in rectosigmoid junction and in the proximal rectum

Anterior resection of the rectum

LAR is appropriate for tumors located in the middle and low rectum

Low anterior resection of the rectum

APR is appropriate for distal rectal cancers that invade the external sphincter or the levator muscles

Abdominoperineal resection

Total abdominal colectomy may be indicated for patients with primary multiple cancer tumors

Total Colectomy

Tatiana N Garmanova, PhD

Viktor V Kakotkin, MD

Mikhail A Agapov, PhD/MD

Tatyana N Garmanova, PhD/MD

Mikhail A Agapov, PhD

The study attempts to quantify the relative risks for mortality, anastomotic leakage and other early and late postoperative complications, recurrence rate, cancer-specific survival, recurrence-free survival after colorectal surgery for patients with colorectal cancer depending on the localization of the tumor.

Factors Affecting the Results of Treatment of Patients With Colorectal Cancer

Anastomotic leakage rate after colorectal resection.

AL is confirmed by one or more of the following conditions:

* fecal discharge from the pelvic drainage at any time after surgery
* rectovaginal fistula defined as fecal or mucus discharge from the vagina
* pelvic sepsis as defined by the collection of pus/ fecal material in the pelvis documented by CT scan
* contrast present outside of the anastomosis as seen by X-Ray contrast enema proctography or CT contrast enema proctography

the overall mortality after colorectal cancer surgery

The number of patients with complications after colorectal resection. All complications will be assessed according to the Clavien-Dindo classification. It consists of 7 grades (I, II, IIIa, IIIb, IVa, IVb and V).

Grade I - Any deviation from the normal postoperative course without the need for treatment.

Grade II - Requiring pharmacological treatment with drugs other than such allowed for grade I complications.

Grade III - Requiring surgical, endoscopic or radiological intervention

* IIIa - Intervention not under general anesthesia
* IIIb - Intervention under general anesthesia Grade IV - Life-threatening complication requiring IC/ICU-management
* IVa - single organ dysfunction (including dialysis)
* IVb - multiorgandysfunction Grade V - Death of a patient

All cases of colorectal cancer recurrence

The number of patients survived within 3 years after the diagnosis

The number of patients without cancer recurrence within 3 years after surgery

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
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
Factors Affecting the Results of Treatment of Patients With Colorectal Cancer	NCT06050447	Colorectal Canc... Colon Cancer Rectal Cancer Colorectal Aden... Colorectal Neop... Rectal Adenocar...	Right hemicolec... Left hemicolect... Sigmoid colon r... Anterior resect... Low anterior re... Abdominoperinea... Total Colectomy	18 Years -	Immanuel Kant Baltic Federal University

Spots Global Cancer Trial Database for sigmoid colon resection