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. 2024 May 20:12:goae047.
doi: 10.1093/gastro/goae047. eCollection 2024.

Laparoscopic ileocecal-sparing vs traditional right hemicolectomy for cancer of the hepatic flexure or proximal transverse colon: a dual-center propensity score-matched study

Jinjie He  1 , Yue Cao  1 , Xiangxing Kong  1 , Siqi Dai  1 , Jun Li  1 , Dong Xu  1 , Yongmao Song  1 , Jianwei Wang  1 , Lifeng Sun  1 , Zhanhuai Wang  1 , Qian Xiao  1 , Lei Ding  1 , Lihao Chen  1 , Cheng Lei  2 , Jian Wang  1 , Haijiang Wang  2 , Kefeng Ding  3   4
Affiliations

Laparoscopic ileocecal-sparing vs traditional right hemicolectomy for cancer of the hepatic flexure or proximal transverse colon: a dual-center propensity score-matched study

Jinjie He et al. Gastroenterol Rep (Oxf). .

Abstract

Background: Traditional right hemicolectomy (TRH) is the standard treatment for patients with nonmetastatic right colon cancer. However, the ileocecum, a vital organ with mechanical and immune functions, is removed in these patients regardless of the tumor location. This study aimed to evaluate the technical and oncological safety of laparoscopic ileocecal-sparing right hemicolectomy (LISH).

Method: Patients who underwent LISH at two tertiary medical centers were matched 1:2 with patients who underwent TRH by propensity score matching based on sex, age, body mass index, tumor location, and disease stage. Data on surgical and perioperative outcomes were collected. Oncological safety was evaluated in a specimen-oriented manner. Lymph nodes (LNs) near the ileocolic artery (ICA) were examined independently in the LISH group. Disease outcomes were recorded for patients who completed one year of follow-up.

Results: In all, 34 patients in the LISH group and 68 patients in the TRH group were matched. LISH added 8 minutes to the dissection of LNs around the ileocolic vessels (groups 201/201d, 202, and 203 LNs), without affecting the total operation time, blood loss, or perioperative adverse event rate. Compared with TRH, LISH had a comparable lymphadenectomy quality, specimen quality, and safety margin while preserving a more functional bowel. The LISH group had no cases of LN metastasis near the ICA. No difference was detected in the recurrence rate at the 1-year follow-up time point between the two groups.

Conclusion: In this dual-center study, LISH presented comparable surgical and oncological safety for patients with hepatic flexure or proximal transverse colon cancer.

Keywords: hemicolectomy; ileocecal sparing; right colon cancer; safety; short-term outcome.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
Schematics, intraoperative images, and specimens. (A) and (B) Schematics of the LISH procedure. The 201p, 201d, 202, and 203 lymph nodes were marked. (C) and (D) Intraoperative images of anastomosis and disconnected vessels during the LISH procedure. (E) and (F) Specimens removed during LISH; (G) and (H) Schematic of the TRH procedure. (I) and (J) Intraoperative images of anastomosis and disconnected vessels during the TRH procedure; (K) and (L) specimens removed during the TRH procedure. LISH = laparoscopic ileocecal-sparing right hemicolectomy, TRH = traditional right hemicolectomy, SMV = superior mesenteric vein, ICA = ileocolic artery, ICV = ileocolic vein, MCA = middle colic artery, MCV = middle colic vein, RCA = right colic artery, SRCV = superior right colic vein.
Figure 2.
Figure 2.
Study flow chart. LISH and TRH patients from the two medical centers were matched based on sex, age, body mass index, tumor location, and disease stage in a 1:2 manner by propensity score matching. Surgical and oncological outcomes as well as perioperative events were compared between the two groups. LISH = laparoscopic ileocecal-sparing right hemicolectomy, TRH = traditional right hemicolectomy.
See this image and copyright information in PMC

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