5 year oncological outcomes of the HIGHLOW randomized clinical trial

Long-term clinical outcomes after high and low ligations with lymph node dissection around the root of the inferior mesenteric artery in patients with rectal cancer

“…According to a study by Slanetz and Grimson [ 12 ] in 1997, the 5-year survival rate was higher in the HL group according to Duke’s classification B and C of rectal cancer patients (Duke’s B: HL [83.9%] vs. LL [73.9%], P<0.01; Duke’s C: HL [52.9%] vs. LL [42.5%], P<0.05), and Singh et al [ 13 ] reported in 2017 that HL had more significant benefits than LL in terms of OS in the IMA positive LNs group (HR, 0.77; 95% CI, 0.66–0.89). However, several recent studies have reported no difference in survival rate according to the ligation level when performing LL with LN dissection around the IMA root [ 15 , 16 , 24 , 26 – 28 ]. As a theoretical concept, HL had a better oncological outcome than LL while dissecting the mesentery from the root of the IMA; however, LL, which preserved the left colic artery while dissecting the LN around the root of the IMA, did not have a worse oncological outcome than HL, which is consistent with the present study.…”

Inferior Mesenteric Artery Ligation Level in Rectal Cancer Surgery beyond Conventions: A Review

“…More recently, Mari G et al [ 84 ] published updated results from the HIGHLOW trial, aimed at reporting the 5-year oncologic outcomes of 196 patients who underwent LAR + TME with either an HTL or LTL of the IMA. The study found no significant differences in the distant recurrence rate (15.8% vs. 18.9%; p = 0.970), pelvic recurrence rate (4.9% vs. 3.2%; p = 0.843), 5-year OS (80.8% vs. 81.9%; p = 0.545), and DFS (79.2% vs. 78%; p = 0.985) between the HTL and LTL, respectively [ 84 ]. Despite its randomized controlled design, the study exhibits several limitations, particularly in terms of the potential influence of preoperative treatments and the precise documentation of the locations of local or distant recurrence within both the HTL and LTL groups [ 85 ].…”

“…The two different methods, HTL and LTL, showed equivalent results in terms of lymph node harvest adequacy (median, 15 (12)(13)(14)(15)(16)(17)(18)(19) vs. 15 (13)(14)(15)(16)(17)(18)(19)(20), p = 0.38), locoregional 5-year RFS (87% vs. 90%; p = 0.456), and 5-year RFS (85% vs. 82%; p = 0.326), respectively [17]. More recently, Mari G et al [84] published updated results from the HIGHLOW trial, aimed at reporting the 5-year oncologic outcomes of 196 patients who underwent LAR + TME with either an HTL or LTL of the IMA. The study found no significant differences in the distant recurrence rate (15.8% vs. 18.9%; p = 0.970), pelvic recurrence rate (4.9% vs. 3.2%; p = 0.843), 5-year OS (80.8% vs. 81.9%; p = 0.545), and DFS (79.2% vs. 78%; p = 0.985) between the HTL and LTL, respectively [84].…”