D2 vs D3 Lymph Node Dissection for Left Colon Cancer

  • End date
    Dec 31, 2028
  • participants needed
  • sponsor
    Russian Society of Colorectal Surgeons
Updated on 6 October 2021


The efficiency of the D3 lymph node dissection is still controversial for left colon cancer patients. This study will try find difference in 5-year overall survival between D2 and D3 lymph node dissection. Investigation of the functional and short-term outcomes will clarify safety of the D3 lymph node dissection.


Discussion about optimal type of lymph node dissection in colorectal cancer continues during last 15 years, when in Europe was presented concept of complete mesocolic excision. However, this concepts is very close to Japanese D3 lymph node dissection and in the first view it seems the same but principal differences were found. Japanese concept is partial resection of the bowel according feeding artery (short bowel specimen, long lymphovascular pedicle), opposite European concept is wide resection of the bowel like hemicolectomy or extended hemicolectomy, sigmoidectomy. In complete mesocolic excision anatomical landmarks are still unclear but in Japanese guidelines it has anatomical margins which can standardize this procedure. Also nerve sparing technique around root of inferior mesenteric artery was described. One more difference is in histological examination of the specimen. European concept is to pay more attention to the quality of complete mesocolic excision and less - to the number of investigated lymph nodes. In Japan lymph node extraction is performed by surgical team from the fresh specimen and send to pathologist separately (each group of lymph nodes). Considering the absence of randomized control trials for patients with left colon cancer DILEMMA trial was started using Japanese approach

Condition Colon cancer; rectal cancer, Malignant neoplasm of colon, colon carcinoma, Colorectal Cancer, Colon Cancer, Colon Cancer Screening
Treatment Left colon resection, Sigmoid colon resection, Distal sigmoid colon resection or anterior resection
Clinical Study IdentifierNCT04364373
SponsorRussian Society of Colorectal Surgeons
Last Modified on6 October 2021


Yes No Not Sure

Inclusion Criteria

Agreement of the patient to participate in trial
Colon cancer (only adenocarcinoma )
The tumor located between the splenic flexure and rectosigmoid junction
Tolerance of chemotherapy
ASA 1-3

Exclusion Criteria

is - 2, 4b (tail of the pancreas, stomach, small bowel, ureter, urinary bladder)
Preoperative complications of the tumor (perforation and full bowel 3. obstruction)
Previous radiotherapy or chemotherapy
Synchronous or metachronous tumors
Women during Pregnancy or breast feeding period
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