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Published in: Annals of Surgical Oncology 13/2013

01-12-2013 | Colorectal Cancer

Survival After Resection of Colorectal Cancer Based on Anatomical Segment of Involvement

Authors: Aneel Bhangu, MBChB, MRCS, Ravi P. Kiran, MBBS, MS, FRCS, FACS, MSc, Alistair Slesser, MBChB, MRCS, J. Edward Fitzgerald, BA, MBChB, MRCS, Gina Brown, MBBS, FRCR, Paris Tekkis, MD, FRCS

Published in: Annals of Surgical Oncology | Issue 13/2013

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Abstract

Purpose

To determine survival differences for patients undergoing colonic or rectal resection for cancer on the basis of the specific anatomical location of primary tumor.

Methods

A total of 143,747 patients undergoing segmental colectomy, hemicolectomy, anterior resection, or abdominoperineal resection (APER) for adenocarcinoma from 1995 to 2009 were identified from 13 Surveillance, Epidemiology, and End Results regions. The primary end point was overall survival determined by adjusted hazard ratios (HRs); the secondary end point was lymph node yield.

Results

Total lymph node yield significantly decreased from proximal to distal resected segment in stage 0–II cancer, but not in stage III cancer. Lymph node ratio increased from cecum to hepatic flexure and then decreased distally (p < 0.001). Adjusted HRs revealed that survival after right colonic resection for ascending hepatic flexure and transverse colon cancer was not significantly different from cecal cancer. Survival after left colonic resection for descending colon cancer was not different from splenic flexure cancer, but sigmoid colectomy carried improved survival (HR 0.95, p = 0.027). APER carried worse survival compared to anterior resection (HR 1.28, p < 0.001) or right colonic resection for cecal cancer (HR 1.61, p < 0.001).

Conclusions

Survival after resection from colorectal cancer depends on specific anatomical segment and not just the division between colon and rectum, or left and right colon. This may be related to inherent differences in the anatomical characteristics of the particular colorectal segment, with varying lymph node yields contributing to understaging. This supports an individualized approach to colorectal cancer, with particular attention to surgical technique, leading to survival improvement.
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Metadata
Title
Survival After Resection of Colorectal Cancer Based on Anatomical Segment of Involvement
Authors
Aneel Bhangu, MBChB, MRCS
Ravi P. Kiran, MBBS, MS, FRCS, FACS, MSc
Alistair Slesser, MBChB, MRCS
J. Edward Fitzgerald, BA, MBChB, MRCS
Gina Brown, MBBS, FRCR
Paris Tekkis, MD, FRCS
Publication date
01-12-2013
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 13/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-3104-5

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