D3 Lymph Node Dissection for Colon and Rectal Cancers

  • Tatsuro YamaguchiEmail author


Regardless of Western countries or Japan, surgical resection is the most effective treatment for colorectal cancer. Therefore, the resection of the primary tumor is recommended in the absence of distant metastasis. However, the concept of colorectal surgery is quite different between Western countries and Japan. In Western countries, the tumor is resected with wide margins in the direction of the colonic axis based on the tumor location. In Japan, the extent of lymph node dissection depends on the degree of tumor progression, which is called D3 lymph node dissection. According to the Japanese Society for Cancer of the Colon and Rectum, regional lymph nodes are categorized into paracolic nodes (located around the marginal artery), intermediate nodes (located around the dominant artery corresponding to the tumor location, such as the right colic artery), and main nodes (located around the branching point of the dominant artery). For D3 lymph node dissection, complete lymphadenectomy from the paracolic to main nodes is required. For lower rectal cancer, D3 lymph node dissection includes dissection of the lateral lymph nodes. Lateral lymph nodes are located outside the mesorectal fascia and are categorized into internal iliac nodes, common iliac nodes, obturator nodes, and external iliac nodes. The internal iliac nodes are further categorized into proximal and distal internal iliac nodes. In this chapter, we describe the Japanese criteria for D3 lymph node dissection for colon and rectal cancers.


Colorectal cancer D3 lymph node dissection Lateral lymph node dissection 


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© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of SurgeryTokyo Metropolitan Cancer and Infectious Diseases Center Komagome HospitalTokyoJapan

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