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RESEARCH PRODUCT

A Proposal for Novel Standards of Histopathology Reporting for D3 Lymphadenectomy in Right Colon Cancer: The Mesocolic Sail and Superior Right Colic Vein Landmarks

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Background Strong agreement exists concerning the standards of pathologic reporting for total mesorectal excision and complete mesocolic excision. It represents a quality standard that correlates with survival. However, no agreed standards of reporting are available to define D3 lymphadenectomy for right colectomy. Objective The purpose of this study was to define anatomopathological standards of specimen quality obtained from the surgical specimen when an oncologic right hemicolectomy with D3 lymphadenectomy has been correctly performed. Design This study was conducted in 2 different phases. The first part consisted of a cadaver-based study of right colon anatomy, and the second part consisted of a prospective assessment of a series of surgical specimens obtained after right hemicolectomy for cancer. Settings The anatomic phase of the study was performed in collaboration with the University of Valencia Department of Anatomy and Embryology. The second part was performed at a colorectal unit of a tertiary hospital. Patients Seventeen cadavers were used for the first phase, and 65 surgical specimens were examined for the second part of the study. Main outcome measures In each specimen, the pathologists looked for anatomic structures defined as markers of quality standards of the D3 lymphadenectomy during the first phase. Specimens were classified as complete, partial, and incomplete D3 lymphadenectomy. Results Twenty percent of specimens were classified as incomplete D3 lymphadenectomy, 31% as partial, and 49% as complete. A median number of 14 (6-64), 22 (11-47), and 29 (14-55) lymph nodes were isolated (p = 0.01). Similarly, the median numbers of lymph nodes isolated in the area of D3 lymphadenectomy were 0 in incomplete, 1 (0-5) in Partial, and 3 (0-8) in Complete D3 lymphadenectomy specimens (p = 0.0001). Limitations A large multicenter study with adequate power is needed. Conclusions We propose the right mesocolic sail and trunk of superior right colic vein as new and reproducible anatomopathologic standards of D3 lymphadenectomy in oncologic right hemicolectomy. See Video Abstract at http://links.lww.com/DCR/B149. PROPUESTA PARA NUEVOS ESTANDARES HISTOPATOLOGICOS EN LA LINFADENECTOMIA D3 EN EL CANCER DE COLON DERECHO: LA VELA MESOCOLICA Y LA VENA COLICA DERECHA SUPERIOR: Existe un claro acuerdo sobre los estandares de calidad patologicos para la escision total del mesorrecto y la escision completa del mesocolon. Son considerados "estandar de calidad" que se correlaciona con la supervivencia. Sin embargo, no se dispone de estandares de calidad para definir la linfadenectomia D3, en la colectomia derecha.Definir los estandares anatomopatologicos de calidad obtenidos de una muestra quirurgica, cuando se ha realizado correctamente una hemicolectomia derecha oncologica, con linfadenectomia D3.Dos fases diferentes. La primera parte consistio en un estudio basado en la anatomia del colon derecho, realizado en cadaveres, y la segunda parte consistio en una evaluacion prospectiva de una serie de muestras quirurgicas obtenidas despues de la hemicolectomia derecha para cancer.La fase anatomica del estudio se realizo en colaboracion con el Departamento de Anatomia y Embriologia de la Universidad de Valencia. La segunda parte se realizo en la Unidad Colorrectal de un hospital terciario.Se utilizaron diecisiete cadaveres para la primera fase y se examinaron 65 muestras quirurgicas para la segunda parte del estudio.En cada muestra, los patologos buscaron estructuras anatomicas definidas, como marcadores de los estandares de calidad de la linfadenectomia D3, durante la primera fase. Las muestras se clasificaron como linfadenectomia D3 completa, parcial e incompleta.El veinte por ciento de las muestras se clasificaron como "Linfadenectomia D3 Incompleta", el 31% como "Parcial" y el 49% como "Completa." Se aislo una media de 14 (6-64), 22 (11-47) y 29 (14-55) ganglios linfaticos respectivamente (p = 0,01). Del mismo modo, el numero medio de ganglios linfaticos aislados en el area de la linfadenectomia D3 fue 0 en "Incompleta", 1 (0-5) en "Parcial" y 3 (0-8) en muestras de "Linfadenectomia D3 Completa" (p = 0,0001).Se necesita un estudio multicentrico con potencia adecuada.Proponemos la vela mesocolica derecha y el tronco de la vena colica derecha superior, como estandares anatomopatologicos nuevos y reproducibles de linfadenectomia D3, en hemicolectomia derecha oncologica. Consulte Video Resumen en http://links.lww.com/DCR/B149.