At the 9th Annual Meeting of the Chinese Medical Doctor Association Colorectal Oncology Committee, Dr. Kefeng Ding from The Second Affiliated Hospital  Zhejiang University School of Medicine presented innovative advancements in laparoscopic ileocecal-sparing hemicolectomy (LISH) for right-sided colon cancer, highlighting its potential to balance oncologic radicality with functional preservation. His insights provide valuable guidance for clinical practice, promoting precision surgery and organ function preservation in colorectal cancer treatment. Oncology Frontier presents key highlights from his lecture.

Advancing Colon Cancer Surgery: The Shift Toward Precision Surgery

The digestive tract, a vital organ system, consists of several key structures—including the mouth, pharynx, esophagus, pylorus, ileocecal valve, and anus—that play essential roles in digestion, absorption, and excretion. The ileocecal valve (ICV) is particularly crucial, serving as a physiological barrier that prevents colonic content reflux, regulates intestinal motility, and maintains gut microbiota homeostasis. However, in traditional right hemicolectomy, the ileocecal valve is routinely removed, regardless of tumor location, disrupting intestinal function and disregarding its physiological importance.

Although conventional right hemicolectomy achieves radical oncologic resection, it does not align with modern precision surgery principles, which prioritize organ function preservation alongside cancer control. This raises a key challenge in the era of precision surgery: how to ensure oncologic efficacy while preserving physiological function.

Introducing LISH: A New Standard for Precision Surgery

LISH (Laparoscopic Ileocecal-Sparing Hemicolectomy) is an innovative surgical approach designed to treat hepatic flexure and proximal transverse colon cancer while preserving ileocecal function. The procedure ensures oncologic safety with a proximal resection margin of at least 5 cm and an adequate lymph node dissection, including No.201d, No.202, and No.203 nodes. The ileocecal valve is preserved, and an end-to-end anastomosis between the cecum and transverse colon is performed.

From an anatomical perspective, LISH is based on the vascular architecture of the ileocolic artery (ICA). The ICA branches into the anterior cecal artery, posterior cecal artery, ileal branch, and appendicular artery. Notably, an anastomosis between the ileal branch and superior mesenteric artery branches ensures adequate blood supply to the terminal ileum. During LISH, selective preservation of the ileal branch prevents anastomotic leakage and ischemic complications.

From an oncologic standpoint, LISH is supported by studies demonstrating that hepatic flexure and proximal transverse colon cancers rarely metastasize to ileocecal lymph nodes. This enables selective tumor removal while preserving the ileocecal valve, ensuring both oncologic radicality and functional preservation.

Clinical Evidence: Safety and Efficacy of LISH

LISH represents a paradigm shift from traditional radical resection to function-preserving surgery in colon cancer treatment. This approach not only ensures complete tumor removal but also preserves key physiological functions, aligning with the evolving principles of precision surgery.

In 2021, Professor Ding’s team published the first international report on LISH, detailing indications, surgical techniques, and procedural videos, marking a significant milestone in the standardization of LISH.

The first phase of LISH research focused on technical feasibility, case selection, and procedural standardization, incorporating key techniques such as:

• Dissection and preservation of ileocolic vascular branches
• Ligation of colonic branches while preserving ileal branches
• Complete mesocolic excision (CME) with lymph node dissection (No.201p, No.202, No.203 nodes)

As the technique matured, phase two focused on evaluating its surgical safety through retrospective matched analysis. The study demonstrated that LISH and traditional right hemicolectomy had comparable intraoperative blood loss, postoperative complication rates, and disease-free survival (DFS), with no perioperative mortality. Importantly, LISH maintained lymph node clearance quality, with no metastases detected in No.201d, No.202, or No.203 nodes.

Most notably, LISH preserved functional bowel segments, facilitating postoperative bowel function recovery. Clinical outcomes confirmed that LISH provides equivalent oncologic safety to traditional right hemicolectomy while maximizing functional preservation.

Expanding the Clinical Adoption of LISH

Following the success of initial studies, LISH has entered a nationwide, multicenter clinical research phase. Led by Professor Ding, this prospective, randomized controlled trial involves 31 leading colorectal cancer centers across China, aiming to compare LISH with conventional right hemicolectomy in hepatic flexure and proximal transverse colon cancer.

The study, with a planned enrollment of 568 patients, has three-year DFS as the primary endpoint, aiming to provide high-level evidence for the widespread adoption of LISH.

With strong collaboration between participating centers, LISH research has rapidly progressed, with multiple academic workshops and protocol refinement meetings. In November 2024, an international exchange forum at the University of Oxford will further advance global integration of this technique.

This ongoing research will establish LISH as a new standard in function-preserving colorectal surgery, providing high-level evidence to support its clinical implementation worldwide. Ultimately, the success of LISH will drive precision surgery and organ-preserving strategies forward, improving outcomes and quality of life for colorectal cancer patients.

Conclusion

The LISH procedure has gained widespread recognition and adoption across China, with multiple medical centers independently implementing this function-preserving surgical approach. Through continuous advancements in anatomical, oncological, and clinical research, LISH has proven its ability to achieve radical tumor resection while preserving organ function.

As more clinical data accumulate and technical refinements continue, LISH is poised to become a standardized surgical option for hepatic flexure and proximal transverse colon cancer. By improving long-term prognosis and quality of life, this approach represents a significant step forward in precision surgery, offering personalized treatment strategies that can ultimately benefit patients worldwide.

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Dr. Kefeng Ding

• Chief Physician, PhD Supervisor
• Chief Scientist, National Major Science and Technology Project for Chronic Diseases
• Chief Scientist, National “13th Five-Year Plan” Key R&D Program
• Executive Deputy Secretary and Vice President, The Second Affiliated Hospital  Zhejiang University School of Medicine
• Distinguished Talent, Zhejiang Provincial “Ten Thousand Talents Plan”
• Qiu Shi Distinguished Physician, Zhejiang University
• Director, Zhejiang Provincial Clinical Medical Center for Malignant Tumors
• Vice Director, Zhejiang University Oncology Institute
• Chair, Surgical Oncology Committee, Chinese Medical Doctor Association Colorectal Cancer Committee
• Chair, NOSES Committee, Chinese Anti-Cancer Association
• Vice Chair, Colorectal Cancer Committee, Chinese Anti-Cancer Association
• Standing Member, Oncology Branch, Chinese Medical Association
• President-elect, Colorectal Cancer Committee, Zhejiang Anti-Cancer Association
• Chair, Precision Medicine Committee, Zhejiang Medical Association
• Principal Investigator for national and provincial research projects, with over 50 SCI-indexed and core journal publications in the past five years