• lymph node metastases (d3 volume)
• d3 right colectomy
• extended d3 mesenterectomy
• oncologic outcomes
• lymph node dissection

• Female
• Humans
• Lymph Node Excision/methods
• Colonic Neoplasms/pathology
• Laparoscopy/methods
• Lymph Nodes/pathology
• Lymphatic Metastasis/pathology

• Colorectal cancer
• Colorectal surgery
• Complete mesocolic excision
• D3 lymphadenectomy
• Right colectomy

• Humans
• Colonic Neoplasms/surgery
• Lymph Node Excision/methods
• Dissection/methods
• Ligation
• Colectomy/methods
• Mesocolon/surgery
• Laparoscopy/methods

• Università degli Studi di Roma Tor Vergata

• Colon cancer
• D3 right colectomy
• Extended D3 mesenterectomy
• Occult tumor cells
• Stages I–III

• Colonic Neoplasms/surgery
• Humans
• Lymph Node Excision/methods
• Lymphatic Metastasis
• Male
• Prospective Studies
• Survival Rate

• Akershus Universitetssykehus

• D2 lymphadenectomy
• D3 lymphadenectomy
• colon cancer
• meta-analysis

• Colonic Neoplasms/surgery
• Humans
• Lymph Node Excision

Chylous ascites following right colectomy has a high incidence which is a critical challenge. At present, there are few studies on the factors affecting chylous ascites after right colectomy and especially after D3 Lymphadenectomy. A predictive model for chylous ascites has not yet been established. Therefore, we created the first nomogram to predict the incidence of chylous ascites after right hemicolectomy.

To analyze the risk factors for chylous ascites after right colectomy and establish a nomogram to predict the incidence of chylous ascites.

We retrospectively collected patients who underwent right hemicolectomy between January 2012 and May 2021 and were pathologically diagnosed with cancer. Multivariate logistic regression was used to analyze the influencing factors of chylous ascites and a nomogram was established. The predictive ability was assessed by the area under the receiver operating characteristic (ROC) curve.

Operative time, the type of operation (standard or extended), the number of lymph nodes retrieved, and somatostatin administration were considered important risk factors. Multivariate logistic regression and nomograms can be used to accurately predict whether chylous ascites occurs. The area under the ROC curve of the model is 0.770. The C-statistic of this model is 0.770 which indicates that it has a relatively moderate ability to predict the risk of chylous ascites.

We found a novel set of risk factors, created a nomogram, and validated it. The nomogram had a relatively accurate forecasting ability for chylous ascites after right hemicolectomy and can be used as a reference for risk assessment of chylous ascites and whether to prevent it after surgery.

• Nomogram
• Right colectomy
• Chylous ascites
• Risk factors

• Central vascular ligation
• Colon cancer
• Complete mesocolic excision
• Feasibility
• Laparoscopic
• Right colectomy

• Colorectal surgery
• D3-mesenterectomy
• colorectal cancer
• extrinsic denervation of the small bowel
• extrinsic nerves
• postoperative bowel function
• postoperative diary
• quality of life
• right colectomy
• superior mesenteric plexus

The impact of the position of the middle colic artery (MCA) bifurcation and the trajectory of the accessory MCA (aMCA) on adequate lymphadenectomy when operating colon cancer have as of yet not been described and/or analysed in the literature. The aim of this study was to determine the MCA bifurcation position to anatomical landmarks and to assess the trajectory of aMCA.

The colonic vascular anatomy was manually reconstructed in 3D from high-resolution CT datasets using Osirix MD and 3-matic Medical and analysed. CT datasets were exported as STL files and supplemented with 3D printed models when required.

Thirty-two datasets were analysed. The MCA bifurcation was left to the superior mesenteric vein (SMV) in 4 (12.1%), in front of SMV in 17 (53.1%) and right to SMV in 11 (34.4%) models. Median distances from the MCA origin to bifurcation were 3.21 (1.18–15.60) cm. A longer MCA bifurcated over or right to SMV, while a shorter bifurcated left to SMV (r = 0.457, p = 0.009). The main MCA direction was towards right in 19 (59.4%) models. When initial directions included left, the bifurcation occurred left to or anterior to SMV in all models. When the initial directions included right, the bifurcation occurred anterior or right to SMV in all models. The aMCA was found in 10 (31.3%) models, following the inferior mesenteric vein (IMV) in 5 near the lower pancreatic border. The IMV confluence was into SMV in 18 (56.3%), splenic vein in 11 (34.4%) and jejunal vein in 3 (9.4%) models.

Awareness of the wide range of MCA bifurcation positions reported is crucial for the quality of lymphadenectomy performed. The aMCA occurs in 31.3% models and its trajectory is in proximity to the lower pancreatic border in one half of models, indicating that it needs to be considered when operating splenic flexure cancer.

The online version of this article (10.1007/s00464-020-08242-8) contains supplementary material, which is available to authorized users.

• 3D printing
• Accessory middle colic artery
• Colonic cancer surgery
• Left colectomy
• Mesenteric vascular anatomy
• Middle colic artery
• Splenic flexure cancer

Adjuvant chemotherapy for colon cancer with lymph node involvement (Stage III) has been the standard of care since the 1990s. Meanwhile, considerable evolvement of surgery combined with dedicated histopathological examinations may have led to stage migration. Furthermore, prognostic factors other than lymph node involvement have proven to affect overall survival. Thus, adjuvant chemotherapy in Stage III colon cancer should be reconsidered. The objective was to compare recurrence rates and survival in stage III colon cancer patients treated with or without adjuvant chemotherapy. Further, to assess the impact of extensive mesenterectomy, lymph node stage and vascular invasion on outcome.

Consecutive patients operated for Stage III colon carcinoma between 31 December 2005 and 31 December 2015 were identified in the pathological code register by matching colon (T67) and either adenocarcinoma (M81403) or mucinous adenocarcinoma (M84803), with lymph node (T08) and metastasis of adenocarcinoma (M81406 or M84806). Medical records of all identified patients were reviewed.

Of 216 identified patients, 69 received no postoperative adjuvant chemotherapy (group NC), 69 insufficient adjuvant chemotherapy (FLV or < minimum recommended 6 cycles FLOX, group IC), and 78 sufficient adjuvant chemotherapy (≥ 6 cycles FLOX, group SC). When adjusted for age and comorbidity, 5-year overall survival did not differ statistically significant between groups (76% vs. 83% vs. 85%, respectively). Vascular invasion and a high lymph node ratio significantly reduced overall survival.

The findings imply that subgroups of Stage III colon cancer patients have good prognosis also without adjuvant chemotherapy. For definite conclusions about necessity of adjuvant chemotherapy, prospective trials are needed.

• Adjuvant chemotherapy
• Complete mesocolic excision
• Lymph node ratio
• Stage III colon cancer
• Vascular invasion

• Colon cancer
• Complete mesocolic excision
• D3 lymph node dissection
• Laparoscopy
• Right hemicolectomy

• Aged
• Colonic Neoplasms/surgery
• Female
• Humans
• Laparoscopy/adverse effects
• Ligation
• Lymph Nodes/pathology
• Male
• Mesenteric Veins/surgery
• Mesocolon/surgery
• Middle Aged
• Postoperative Complications/etiology

We aim to find the incidence of chylous ascites in patients undergoing D3 extended mesenterectomy and evaluate if a routine fat-reduced diet (FRD) has a prophylactic effect.

Data from 138 patients included in a D3 extended mesenterectomy trial were collected prospectively. Surgical drains and biochemical testing of drain fluid were used to find the incidence of chylous ascites among the first 39 patients, and a prophylactic fat-reduced diet was then implemented in the next 99 patients as a prophylactic measure.

In the first 39 patients, we found that 16 (41.0%) developed chylous ascites. After the fat-reduced diet was implemented, 1 (1.0%) of 99 patients developed chylous ascites. Drain discharge was 150 vs. 80 mL daily, respectively, and a regression analysis shows the average leakage in the group with fat-reduced diet was 105 mL/day less than in the patients with no dietary restrictions (p < 0.001). There were no significant differences in the rate of other complications (Fisher exact test, one-tailed p = 0.8845), and although there was a tendency to a shorter hospital stay when given a fat-reduced diet (7.3 ± 5.4 vs. 8.9 ± 4.9 days), the difference was not significant (p = 0.19).

Chylous ascites is a very common postoperative occurrence after right colectomy with extended D3 mesenterectomy and may be prevented using a routine fat-reduced diet.

• Chylous ascites
• D3 extended mesenterectomy
• Fat-free diet
• Fat-reduced diet
• Lymphatic leak

• Aged
• Colectomy/methods
• Colon, Transverse
• Colonic Neoplasms/surgery
• Female
• Humans
• Laparoscopy
• Lymph Node Excision
• Male
• Mesocolon/surgery