The impact of D2 lymphadenectomy on pathology understaging of right colon cancer

Fabio Carbone, Ahmad Alsaleh, Shahnawaz Rasheed, Paris Tekkis, Christos Kontovounisios


The question of how extensive lymphadenectomy should be in right colon cancer (RCC) surgery remains widely debated in the literature. A correct evaluation of the lymph node status of the surgical specimen is essential for staging and need for adjuvant therapy. Surgery and lymph node assessment are both important factors that influence the lymph node staging. Currently the European and American guidelines recommend the removal of a minimum number of 12 lymph nodes while the Japanese guidelines suggest modulating lymphadenectomy according to the stage of the disease. D2 lymphadenectomy can lead to downstaging of the disease due to several physiopathological mechanisms. The aim of this manuscript is to show the different factors that play a role in a better pathological evaluation of the lymph node status for RCC.