Background and Objective: Literature indicates that 4–11.5% patients operated for cure of colon cancer develop loco-regional recurrence. Complete mesocolic excision (CME) with level of dissection III (D3) in surgical treatment of colon cancer aims to improve lymph node harvest. The objective is to present a patient with nodal recurrence in the D3 volume 3 years after initial right colectomy for cancer, after receiving adjuvant treatment. A comprehensive video of complete D3 volume removal in order to achieve R0 resection is presented.

Methods: Before surgery, the staging computed tomography (CT) dataset was used for 3D vascular anatomy reconstruction, including the identification, caliber (internal diameter) and course of the vascular structures within the root of the mesentery. The metastatic node was also reconstructed, and its position determined to the vascular structures. The operative plan of minimally invasive surgery was carried out by Da Vinci robot, with the dissection and removal of the entire D3 volume, and the patient was put on a three-day postoperative low-fat diet in order to prevent chylous ascites. The literature search was accomplished through PubMed, the Cochrane Central Register of Controlled Trials and Embase.

Key Content and Findings: The control CT 3 years after right colectomy revealed an enlarged lymph node anterior to the superior mesenteric artery at the level of the origin of the middle colic artery, short axis 13 mm, confirmed by positron emission tomography as metastasis. Complete D3 volume removal revealed a lymph node conglomerate containing several lymph node metastasis from adenocarcinoma, with vascular and perineural infiltration. The patient didn’t receive any adjuvant treatment after the second surgery and is alive and recurrence free at 7 years after primary and 4 after redo surgery. The literature search on locoregional recurrence after surgery for cure of colorectal cancer revealed only 15 articles in the last 20 years.

Conclusions: The incidence of local nodal recurrence seems to be significantly lower after the introduction of CME/D3 surgical technique. We present a surgical technique of D3 extended mesenterectomy as an option for the treatment of nodal recurrence in the central (D3 volume) after right colectomy for cancer through minimally invasive access (robotic) surgery.