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Observational Study
. 2025 Sep 2;29(1):166.
doi: 10.1007/s10151-025-03182-8.

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

F Pfeffer  1   2 , P Kalgraff  3 , K B Lygre  3   4 , B S Nedrebø  3 , H M Forsmo  3   4
Affiliations
Observational Study

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

F Pfeffer et al. Tech Coloproctol. .

Abstract

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.

Keywords: Lymphadenectomy; Mesenteric lymph node dissection; Right-sided colon cancer; Specimen evaluation; Surgical quality assessment; Visual analogue scale.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
A Preoperative computed tomography (CT) with contrast, 1-mm slice thickness, and three-dimensional volume rendering Osirix reconstruction of the root of the midgut mesentery. B Same patient as in A, image acquired at surgery. C Schematic drawing of the mesenteric vessels superior mesenteric vein (SMV) and superior mesenteric artery (SMA) at the level of the ileocolic vessels combined with a visual analogue scale. Categorical lymph node dissection: D2, complete D2 (cD2), complete mesocolic excision (CME), and D3. Red arrow represents the extent of lymphadenectomy as shown in B. VAS score 9.8. Lymph node (LyN0), ileocolic vein (ICV), gastrocolic trunk of Henle (GTH), middle colic artery (MCA), right colic artery (RCA), superior mesenteric vein (SMV), and superior mesenteric artery (SMA)
Fig. 2
Fig. 2
Density plot to illustrate the distribution of the VAS score and the total number of lymph nodes harvested. A All patients. B Patients grouped after the surgeon’s categorical classification
Fig. 3
Fig. 3
Relationship between VAS score and total number lymph nodes harvested analyzed with linear regression and Pearson’s correlation coefficient
See this image and copyright information in PMC

References

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