Proposal of a new visual analogue scale to describe the extent of lymphadenectomy in right-sided colectomy for cancer-a prospective observational study.

Background: Lymphadenectomy in right-sided colon cancer lacks standardized reporting. The aim was to develop a visual analogue scale (VAS) based on mesenteric vessels to describe the extent of lymphadenectomy.

Methods: We included patients undergoing surgery for right-sided colon cancer from January 2021 to September 2024. Data were collected via a web-based database. Immediately after surgery, surgeons recorded the VAS score, vascular visualization, and specimen quality.

Results: Data from 155 patients were analyzed. Median age was 74 (IQR: 68-80), with 53% female. The median VAS score was 8.2 (IQR: 7.8-8.9). The superior mesenteric vein (SMV) was visualized in 84% of cases, with a median VAS score of 8.4 (IQR: 8.0-9.2) for visualized and 7.0 (IQR: 6.8-7.5) for non-visualized (p < 0.001). The gastrocolic trunk of Henle (GTH) was visualized in 51%, with a median VAS score of 8.7 (IQR: 8.3-9.7) for visualized and 7.9 (IQR: 7.3-8.0) for non-visualized (p < 0.001). Specimen quality was Type 0 (best) in 54% (VAS score 8.6, IQR: 8.2-9.5), Type I in 37% (VAS score 7.9, IQR: 7.3-8.0), and Type II in 6% (VAS score 6.9, IQR: 6.5-7.9; p < 0.001). A positive correlation between VAS score and lymph node count was found (r = 0.43, p < 0.001).

Conclusions: The VAS score is a reliable and feasible method to describe lymphadenectomy in right-sided colon cancer. Unlike categorical classifications, the VAS score is based on anatomical landmarks and does not depend on consensus definitions. It reflects the visualization of vascular structures and correlates with specimen quality and lymph node yield.

Clinical Trial: ClinicalTrials.gov Identifier NCT06329102 (registered on March 24, 2024).

Article Type: Prospective observational study.