D3 Lymphadenectomy for Right- Sided Colon Cancer– a Mini-review

The objective of this review of the literature is to detail the technical challenges associated with D3 lymphadenectomy for right-sided colon cancer, and to examine the terms used throughout the medical literature to describe the central lymph nodes. We conducted a review of the relevant English language literature, using the electronic search of the PubMed/Medline and Google Scholar databases. The medical literature does not indicate a clear limit between the D3 and D2 lymph nodes for right colon cancer. The central lymph nodes are defined as those located within one centimeter from the origin of the colic arteries. The D3 lymphadenectomy includes ligation of the right colon feeding arteries at their emergence from the superior mesenteric artery (SMA), thus allowing appropriate dissection of the central lymph nodes. The lymphadenectomy of the central lymph nodes requires dissection posterior to the superior mesenteric vein (SMV) when colic arteries have a posterior trajectory to this anatomical structure. An oncological resection for the right-sided colon cancer, with transection of feeding vessels at their emergence from the SMA, is technically demanding, especially when ileocolic and right colic arteries have a trajectory posterior to the SMV.