January's paper evaluates the long-term oncological outcome of the conventional versus the no-touch isolation technique in colon cancer resections.
Long-term follow-up of the conventional versus no-touch isolation technique for resection of primary colon cancer (JCOG1006): randomized clinical trial
Koji Komori, Yasumasa Takii, Junki Mizusawa, Yukihide Kanemitsu, Satoshi Ikeda, Takaya Kobatake, Tetsuya Hamaguchi, Hiroshi Katayama Study Group of Japan Clinical Oncology Group (JCOG), Manabu Shio
BJS Open, Volume 8, Issue 6, December 2024, zrae133
What is known about the subject?
Two main surgical approaches for colon cancer have been identified in the literature: 'a ligation first followed by mobilisation of the tumour approach' or 'mobilisation followed by ligation approach'. These approaches have been described as 'a medial-to-lateral group' and 'lateral-to-medial group' or ‘caudal-to cranial plus artery first’ and 'conventional medial approach'. The 'medial-to-lateral' is comparable to the 'No Touch' which prioritises CVL followed by the mobilisation of the tumour-bearing colon segment and the latter to the ‘Conventional’ techniques used in this study.
The no-touch isolation technique (‘No Touch’) aims to reduce the risk of cancer cells spreading to the liver and other organs.
However, there are different studies which failed to demonstrate of 'No Touch' over 'Conventional'.
What does this study add?
JCOG1006 was a multicentre, open label, randomised, phase III study and compared 'No Touch' and 'Conventional' using disease-free survival (DFS) based on the intention-to-treat principle as the primary endpoint.
The authors performed a primary analysis at 3-year follow-up and a final analysis at 6-year follow-up.
In both arms, the laparoscopic approach was prohibited, as the standard procedure for colon cancer in Japan was open surgery at the time the JCOG1006 commenced.
In total, 853 patients were randomised to the ‘Conventional’ (427) or ‘No Touch’ (426) arms between January 2011 and November 2015. In total, 137 and 140 patients experienced recurrence, secondary cancer or died in the ‘Conventional’ and ‘No Touch’ arms respectively, with 35 developing recurrence, secondary cancer or dying beyond the initially planned 3-year analysis period.
The 6-year DFS was 70.3% (95% c.i. 65.7 to 74.4) and 69.4% (95% c.i. 64.8 to 73.6) in the ‘Conventional’ and ‘No Touch’ arms respectively, with an HR of 1.030 (95% c.i. 0.813 to 1.304; one-sided P = 0.60). This finding is consistent with those of the primary analysis, failing to support the superiority of the ‘No Touch’ technique over the ‘Conventional’ technique in patients with Stages II and III colon cancer.
Implications for colorectal practice
The present 6-year follow-up analysis of this prospective study, which includes a substantial number of participants, also fails to demonstrate the superiority of the 'No Touch' technique over the 'Conventional' technique in terms of long-term DFS and OS in patients with stage II and III colon cancer. Therefore, both approaches can be used for managing colon cancers.