Personalized approach for high-volume operations of the right-sided colon cancer considering prognostic factors. Problem status and results of the own research (a systematic review)
Summary. Colorectal cancer (CRC) in the structure of oncological morbidity and mortality occupies a leading position in Ukraine and in the World. A high rate of increase in the CRC incidence, especially cancer of the right-sided colon cancer (RSCC) has been registered in Ukraine in the last five years, in addition, significant changes registered in the age group patients due to the people over 60. An increase in the number of colorectal patients with various complications and the spread of the tumor process, especially at a young age, caused by the COVID-19 pandemic and military actions in Ukraine, was also registered. RSCC at II–III stages of the disease is associated with worse overall survival (OS) and recurrence-free survival (FRS) due to the variability of the surgical technique of right-sided hemicolectomy. The standard volume for excision of lymph nodes groups in RSCC has not been determined at the now. According to the Japanese clinical guidelines, D3 lymphadenectomy is necessary in all stages except stage I, while according to the European clinical guidelines, the standard High-volume operations of surgery includes only D2 lymphadenectomy. At present, there is no consensus and no evidence-based randomized trial results regarding the differences between D2 and D3 lymphatic dissection in RSCC. In addition, prognosis in both CRC and RSCC has traditionally relied on TNM staging, developed by the UICC and AJCC. However, from the point of clinical symptoms, there are differences in survival patterns in RSCC. Risk stratification and predicting for patients with RSCC depend on many factors. Pathomorphological, immunohistochemical markers and molecular-genetic markers that could be independent predictors for timely detection of recurrence RSCC were analysed in our work. The study itself contains a comprehensive retrospective review and analysis of the indicators of 99 patients with RSCC who underwent laparoscopic right hemicolectomy with D2, D3 dissection in the Non-profit Organization «National Cancer Institute» for the period 2017–2023. The effectiveness treatment analysis for patients with RSCC was carried out based on the Kaplan-Meier survival model with the determination and assessment of the median and average survival rate in 41 operated patients during the five-year observation period. The purpose of this research is to determine the prognostic factors that can be associated with OS and FRS in operated cancer patients with stage II–III RSCC. Research methods used in this research: The literature search was carried out by analysing the databases PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang, NCCN, and the National Cancer Registry of Ukraine. The meta-analysis included international retrospective cohort studies for comparison with investigation group of patients operated on for RSCC in the Non-profit Organization «National Cancer Institute» over a five-year period.
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