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)
Russian Society of Colorectal Surgeons
1,381 participants
Mar 31, 2020
INTERVENTIONAL
Conditions
Summary
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.
Eligibility
Inclusion Criteria8
- Agreement of the patient to participate in trial
- Colon cancer (only adenocarcinoma )
- The tumor located between the splenic flexure and rectosigmoid junction
- cT3-Т4а,b
- cN0-2
- cM0
- Tolerance of chemotherapy
- ASA 1-3
Exclusion Criteria5
- сТis - Т2, сТ4b (tail of the pancreas, stomach, small bowel, ureter, urinary bladder)
- Preoperative complications of the tumor (perforation and full bowel 3. obstruction)
- Previous radiotherapy or chemotherapy
- Synchronous or metachronous tumors
- Women during Pregnancy or breast feeding period
Interventions
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.
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.
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.
Locations(1)
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NCT04364373