Clinicopathological and outcome differences between right and left colon cancer: An institutional experience from South India

747 Background: A SEMS (Self Expandable Metallic Stents) has been widely used for obstructive colorectal cancer as a bridge to surgery to avoid emergency surgery. However, it may increase the tumor spillage so that the long-term survival would be compromised. The aim of our study was to compare the short- and long-term outcome of surgery after stent insertion with those of emergency surgery alone for the left colon malignant obstruction patients. Methods: The medical records of patients who received curative resection due to obstructive primary left colon cancer and diagnosed to stage II or III from January 2004 to December 2010 in six hospitals affiliated to the Catholic Medical Center. Overall survival and disease free survival were compared between the SEMS (n = 158) and emergency surgery (n = 56) group. Short-term outcome was also compared. Factors affecting disease-free survival in the SEMS group were analyzed using the cox proportional hazards model. Results: Baseline characteristics were comparable between two groups by pathologic stage. Intra-operative complication (0.0% vs. 7.1%, p = 0.004), re-operation (1.3% vs. 7.1%, p = 0.042), post-operative hospital stay (11.2 ± 6.5 days vs. 14.6 ± 8.9 days, p = 0.010) and conversion rate (3.5% vs. 16.7%, p = 0.028) showed short-term advantages of the SEMS. 5-year DFS in stage II patients was 87.2% for the SMES group, 73.5% for the ES group (p = 0.117). Among stage III patients, 5-year DFS was 55.8% for the SEMS group and 72.0% for the ES group (p = 0.129). 5-year OS of the SEMS group was 90.2%, and of the ES group was 92.4% in stage II patients (p = 0.694). 5-year OS in the SEMS group was 82.8%, and the ES group 73.0% in stage III patients (p = 0.577). For the stage III SEMS patients, hospital of procedure (p = 0.041) and operation date (HR 0.400, 95% C.I 0.176-0.905, p = 0.028) were independent factors on disease free survival. Conclusions: If there’s an intervention team with sufficient experience for the SEMS and a sufficient preparation for emergency surgery, the SEMS is a good therapeutic option for malignant obstruction in left colon cancer.

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Metastatic pattern and tumor sidedness in colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e15147 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e15147-e15147

Author(s):

Mahvish Muzaffar ◽

Abdul Rafeh Naqash ◽

Darla K. Liles ◽

Sumyra Kachru

Keyword(s):

Colorectal Cancer ◽

Colon Cancer ◽

Regression Model ◽

Predictive Factor ◽

Primary Tumor ◽

Left Colon ◽

Cancer Site ◽

Metastatic Colon Cancer ◽

Metastatic Pattern ◽

Left Colon Cancer

e15147 Background: Tumor side has emerged as an important prognostic and predictive factor in metastatic colon cancer. We sought to study its impact on the metastatic pattern of colorectal cancer. Methods: The SEER database (version 8.3.5) was reviewed for patients with Stage IV colorectal cancer diagnosed between 2004-2015. We only included patients with labeled primary site, and excluded appendiceal, unlabeled and autopsy alone cases. Variables included in the analysis were: age, race, gender, grade, primary tumor side and sites of metastasis at diagnosis. Primary outcome analyzed was overall survival and disease specific survival.Cox proportional hazard regression model was employed to test the association between survival and side of cancer/ site of metastasis. Results: A total of 74,768 cases were identified who met the eligibility criteria. The mean age was 68.5 yrs. for right colon cancer (RCC),64.0 yrs. for left colon cancer (LCC). and 62.9 yrs. for rectal cancer. White race was predominant group for RCC, LCC and rectum. More females were vs men in RCC (52% vs 48%), LCC (44% vs 56%) and rectum (60% vs 40%). (The cox regression model suggested inferior outcome for black race HR 1.05(1.03-1.07) (<0.001), high grade HR 1.32(1.30-1.35) p<.0001, right side tumors HR 1.23(1.21-1.250, p <.0001 (table). Conclusions: Over last few years tumor sidedness has emerged as an important prognostic and predictive factor in colon cancer. Our study also highlights the impact of sidedness on survival irrespective of distant metastatic pattern. This analysis contributes to the ongoing discussion that right and left colon cancer are two distinct disease entities. Impact of primary tumor side and metastatic site on survival in colorectal cancer. [Table: see text]

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