ObjectiveLymph node metastasis status directly influences surgical strategies for right-sided colon cancer. This real-world study aimed to clarify the patterns of regional and extra-regional lymph node metastasis to provide evidence for clinical decision-making and future research. MethodsA total of 123 patients who underwent laparoscopic right hemicolectomy with complete mesocolic excision (CME) at the Department of Gastrointestinal Surgery, Deyang People’s Hospital from September 2022 to May 2024 were included. Lymph nodes were dissected, classified, and analyzed according to the Japanese Society for Cancer of the Colon and Rectum Guidelines for Colorectal Cancer Treatment (7th edition). Clinicopathological data were analyzed. ResultsOverall lymph node metastasis rate:42.3% (52/123). The metastasis rate of para-intestinal lymph nodes (N1) was 33.3%(41/123), intermediate lymph node(N2) 10.6%(13/123), and central lymph node (N3) 13.8% (16/123). Cecal cancer: Ileocolic artery lymph node metastasis rate: 40.0% (10/25), right colic artery: 0% (0/6) and middle colic artery: 4.0% (1/25). Transverse colon cancer: Ileocolic artery lymph node metastasis rate: 0%(0/18) and middle colic artery: 33.3% (6/18). Of 45 patients with infrapyloric lymph node dissection, only 1 (2.2%) with hepatic flexure cancer showed metastasis. No ileal lymph node metastasis was observed. N3 metastasis rates: 9.3% (8/86) in well/moderately differentiated tumors vs. 21.6% (8/37) in poorly differentiated tumors. No N3 lymph node metastasis occurred in T1～2 tumors. T3 and T4 tumors exhibited N3 metastasis rates of 13.3% (13/98) and 21.4% (3/14), respectively. ConclusionsFor cancer of the ileocecal region, lymph node metastasis beside the colic middle artery almost never occurs. And for transverse colon cancer, no lymph node metastasis beside the ileocolic artery has been found. suggesting that when the tumor is located in these areas, excessive resection of the intestine is not necessary, and a right hemicolectomy with ileocecal preservation can be performed to better preserve organ function. For poorly differentiated cancers and right-sided colon cancers on T3 and T4 stages, the N3 lymph node metastasis rates are very high, respectively, and D3 lymph node dissection is still recommended. The rate of extra-regional lymph node metastasis is extremely low, and routine dissection is not recommended.