KEY TAKEAWAYS
- A new surgical technique called LISH preserves the ileocecum. This single-arm prospective study evaluated the feasibility of LISH in patients with hepatic flexure and proximal transverse colon cancer.
- Critical endpoints included postoperative complications, local recurrence, conversion to TRH, lymphadenectomy quality, CME quality, surgical margin, and DFS rate at 1 year.
- All patients showed negative resection margins and sufficient proximal resection margins, and metastatic involvement in 201d/202/203 lymph nodes was undetected.
The standard surgical approach for right colon cancer is traditional right hemicolectomy (TRH). This procedure entails removing a segment of the large intestine, including the ileocecum, which is believed to contribute to digestion and immune functions. The study explored the feasibility and oncological efficacy of ileocecal-sparing hemicolectomy (LISH) for treating cancers in the hepatic region and proximal transverse colon.
In this study, dissection encompassed the lymphatic fatty tissue around the ileocolic artery and vein (ICA/ICV), involving 201d (lymph node around the colic branch of ICA), 202, and 203LN, and the LISH procedure was previously detailed. Colic branches of ICA/ICV were selectively ligated, preserving the main trunk, cecal branches, and ileal branches. The ligation of the right colic artery/vein and middle colic artery/vein at the roots mirrored the approach in TRH. An anastomosis was created between the cecum and transverse colon via an opening at the base of the cecum.
This single-arm prospective study examined LISH’s feasibility. Inclusion criteria included patients aged 18-75 with hepatic flexure and proximal transverse colon cancer, excluding distant metastasis. The study evaluated secondary outcomes of postoperative complications, local recurrence, TRH conversion rate, lymphadenectomy, CME quality, surgical margin status, and 1-year DFS rate.
A total of 31 patients were evaluated as of Jan. 16, 2022, comprising 9 at stage I, 9 at stage II, and 13 at stage III. All patients underwent successful LISH. The high-quality lymphadenectomy rate (harvested LN > 12) was 96.8%, and the high-quality CME rate (Grade I/II) was 100%. Resection margins were negative for all patients, with a median proximal resection margin of 9.1cm. Evaluation of 201d/202/203 lymph nodes revealed no metastatic involvement. Within 90 days, 19.4% experienced Clavien-Dindo grade I adverse events, including wound infection (n = 2), anemia (n = 2), diarrhea (n = 1), and intestinal obstruction (n = 1). The 1-year local recurrence rate was 0%, while the 1-year disease-free survival (DFS) rate stood at 96.77%. Remarkably, a sole stage III patient received a diagnosis of ovarian metastases nine months following the radical operation.
LISH shows promise for hepatic flexure and proximal transverse colon cancer, with favorable safety, satisfactory quality, and promising initial oncologic outcomes in the first year.
A multicenter phase III study is underway to evaluate the long-term oncological efficacy of LISH further.
Source: https://ascopubs.org/doi/10.1200/JCO.2023.41.16_suppl.e15650
Clinical Trial: https://www.clinicaltrials.gov/study/NCT04479111
Ke-Feng Ding, Jinjie He, Yue Cao, Xiangxing Kong, Yue Liu, Siqi Dai, Jian Wang, Jun Li, Dong Xu, Yongmao Song, Jianwei Wang, Lifeng Sun, Zhanhuai Wang, Qian Xiao, Lei Ding, Lihao Chen. DOI 10.1200/JCO.2023.41.16_suppl.e15650, J Clin Oncol 41, 2023 (suppl 16; abstr e15650)
