Is Standardized Right Hemicolectomy with D2 Lymphadenectomy Enough to Limit Local Recurrence in Adenocarcinoma of the Right Colon?

Objective: To identify tumor-related and pathological predictors of local recurrence (LR) following laparoscopic right hemicolectomy with standardized complete mesocolic excision (CME) and D2 lymphadenectomy for stage I-III right-sided colon cancer, and to delineate distinct patterns of local versus distant recurrence. Summary background data: While CME with central vascular ligation is advocated to improve oncologic outcomes in colon cancer, its true impact remains controversial. Most evidence focuses on surgical technique and nodal yield, often underestimating the role of tumor biology. Moreover, standard survival analyses fail to adequately account for competing events, potentially skewing recurrence estimates. Methods: We retrospectively analyzed 400 consecutive patients who underwent laparoscopic right hemicolectomy with CME and D2 lymphadenectomy between 2017 and 2024. Recurrence patterns were evaluated using Fine-Gray competing risk models to identify independent predictors of local and distant relapse. Results: With a median follow-up of 39 months, LR occurred in only 2.5% of patients, whereas 9% developed distant metastases. Among all variables, only the presence of a tumor in the proximal transverse colon was independently associated with a higher LR risk (subdistribution hazard ratio[sHR] 5.3; P=0.016). Perineural invasion (sHR 2.74; P=0.019) and advanced nodal stage (sHR 5.59; P<0.001) significantly predicted distant relapse. Conclusions: Standardized CME with D2 lymphadenectomy ensures excellent local control in right-sided colon cancer. However, proximal transverse colon tumors exhibit a unique pattern of LR. Incorporating tumor location and pathological risk factors into surgical planning could support a more personalized, biology-driven approach to colorectal cancer treatment.