The Role of Total Abdominal Autonomic Nerve Preservation During the Resection of Right/Left Colon Cancer: Prospective Clinical Trial

This prospective controlled trial was done in FUSCC. Eligible patients were aged 18-75 years with histologically confirmed primary adenocarcinoma located between the caecum and the descending colon, without evidence of distant metastases. Participants were randomly assigned (1:1) to TNP or CME during laparoscopic right/left colectomy. Abdominal autonomic nerve were dissected in the CME but not in the TNP procedure. Neither investigators nor participants were masked to their group assignment but the quality control committee were masked to group assignment. The primary endpoint was postoperative bowel function recovery, including defecation frequency, diarrhea and enterospasm; The secondary outcomes were 3-year disease-free survival, intraoperative surgical complications and postoperative complications within 30 days of surgery, graded according to the Clavien-Dindo classification, mortality (death from any cause within 30 days of surgery), and central lymph node metastasis rate.

Inclusion criteria

• 18-75 years old
• Pathologically confirmed adenocarcinoma of right side of colon and descending colon.
• Localization of the tumor ranging from the cecum to the descending colon
• Tumors clinically staged as T2-4aN0M0 or TanyN + M0, according to imaging studies including enhanced computed tomography (CT) scan, magnetic resonance imaging (MRI), etc.
• American Society of Anesthesiologists (ASA) score of I, II, or III.

Exclusion criteria

• Synchronous or metachronous multiple primary colorectal cancer
• Preoperative imaging examination shows enlargement of the central lymph nodes, which mandates a D3 lymphadenectomy
• Preoperative imaging examination shows that the tumor involves the adjacent organs, requiring combined multiple organ resections, or radical excision (R0 resection) is not possible
• History of any other malignant tumor in past 5 years, except for cervical carcinoma in situ that has been cured, basal cell carcinoma, or squamous cell carcinoma of skin
• Patients who need an emergency operation
• Patients who are not suitable to undergo laparoscopic surgery (due to, e.g., extensive adhesion caused by prior abdominal surgery, inability to endure artificial pneumoperitoneum, etc.).