Similarities and differences between D3 lymphadenectomy and complete mesocolic excision of right hemicolonectomy / 中华胃肠外科杂志

D3 lymphadenectomy and complete mesocolic excision (CME) for colon cancer, which have been introduced to China for more than 10 years, are two major surgical principles worldwide. However, there are still many different opinions and misunderstandings about the core principles of D3 and CME, especially the similarities and differences between them. However, few articles have been published to discuss these issues specifically. Domestic scholars' understandings about D3 lymphadenectomy and CME for right hemicolectomy are quite different. Two different concepts including "D3/CME" and "D3+CME" have become mainstream views. The former equate D3 with CME and the latter seems to regard them as totally different principles. There is no consensus on which one is more reasonable. Therefore, this article aims to discuss the similarities and differences between D3 and CME for right hemicolectomy in perspectives of the theoretical background, surgical principles, extent of surgery and oncological outcomes. We believed that D3 and CME do not belong to the same concept, and that the scope of CME surgery for right-sided colon cancer is greater than and includes the scope of D3 surgery, and that D3 and CME are not complementary.

Risk factors and prevention measures of anastomotic leak after right hemicolectomy for cancer / 中华胃肠外科杂志

The incidence of anastomotic leak after right hemicolectomy for cancer is relatively low, but it may be misjudged. In recent years, the results of some multi-center or nationwide registration studies in Europe have shown that the incidence of anastomotic leak is significantly higher than that of eastern countries. The reasons of these differences may be the different nature of the studies, the lack of rigor in diagnostic criteria or diagnostic methods, the difference in the level of specialization of hospitals or surgeons, and so on. Timely treatment of preoperative comorbidities, reasonable selection of preoperative bowel preparation and anastomotic technique/method might reduce the occurrence of anastomotic leak. The current evidence shows complete mesocolic excision (CME) does not increase the risk of anastomotic leak. The clinical features of ileo-colic anastomotic leak are different from those of rectal surgery. The mild cases can be treated conservatively, and the severe cases are suggested to receive timely diverting ileostomy.