Clinical Scorecard: Development of a Novel Visual Analogue Scale for Assessing Lymphadenectomy Extent in Right-Sided Colectomy for Cancer: A Prospective Observational Analysis

At a Glance

Key Highlights

• Right-sided colon cancer surgery involves complex vascular anatomy with multiple branches from superior mesenteric artery and vein.
• Radical lymphadenectomy techniques such as D3 dissection and complete mesocolic excision (CME) are associated with improved survival outcomes in advanced stages.
• A novel visual analogue scale (VAS) based on vascular anatomy was developed to objectively quantify the extent of lymphadenectomy.

Guideline-Based Recommendations

Diagnosis

• Preoperative contrast-enhanced CT with 1-mm slices and 3D reconstruction recommended to assess vascular anatomy and suspicious lymph nodes.

Management

• National guidelines in Norway recommend dissection and vascular ligation along the right side of the superior mesenteric vein (cD2).
• D3 dissection is advised if suspicious central lymph nodes are identified preoperatively.
• Complete mesocolic excision (CME) and D3 lymphadenectomy may improve disease-free survival in stage III colon cancer.

Monitoring & Follow-up

• Intraoperative visualization of mesenteric vessels and specimen quality assessment are important for confirming lymphadenectomy extent.

Risks

• Concerns about major complications influence extent of lymphadenectomy; lack of consensus on D3 dissection extent may affect surgical risk.

Patient & Prescribing Data

155 patients undergoing right-sided colon cancer surgery at a tertiary center in Norway

Use of the visual analogue scale correlated with surgeon classification and lymph node harvest, supporting its utility in standardizing lymphadenectomy extent.

Clinical Best Practices

• Utilize preoperative CT with 3D reconstruction to map vascular anatomy and plan lymphadenectomy.
• Apply the visual analogue scale to objectively quantify lymphadenectomy extent intraoperatively.
• Follow national guidelines recommending cD2 dissection with escalation to D3 if central lymph nodes are suspicious.
• Ensure preservation and clear identification of key vascular structures (SMV, SMA, ileocolic vessels, gastrocolic trunk of Henle) during surgery.
• Standardize terminology and definitions of lymphadenectomy extent to improve comparability and outcomes.

References

• Japanese classification of lymph node dissection (D3)
• European definition of complete mesocolic excision (CME)
• Survival advantage of D3 lymph node dissection in pT3/pT4 colon cancer
• Bertelsen et al. on CME reducing recurrence and improving survival
• RESECTAT trial exploratory analysis on CME
• RELARC study on disease-free survival with CME
• Norwegian national guidelines on right-sided colon cancer lymphadenectomy
• Systematic review on variability in radical right-sided colon cancer surgery definitions
• Anatomical study of superior mesenteric vessels and lymphadenectomy borders
• Randomized trial comparing open D3 lymphadenectomy with laparoscopic CME