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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2018

01-02-2018 | Gastrointestinal Oncology

The Impact of Primary Tumor Location on Long-Term Survival in Patients Undergoing Hepatic Resection for Metastatic Colon Cancer

Authors: John M. Creasy, MD, Eran Sadot, MD, Bas Groot Koerkamp, MD, Joanne F. Chou, MD, Mithat Gonen, MD, Nancy E. Kemeny, MD, Leonard B. Saltz, MD, Vinod P. Balachandran, MD, T. Peter Kingham, MD, Ronald P. DeMatteo, MD, Peter J. Allen, MD, William R. Jarnagin, MD, Michael I. D’Angelica, MD, FACS

Published in: Annals of Surgical Oncology | Issue 2/2018

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Abstract

Background

The impact of primary tumor location on overall survival (OS), recurrence-free survival (RFS), and long-term outcomes has not been well established in patients undergoing potentially curative resection of colorectal liver metastases (CRLM).

Methods

A single-institution database was queried for initial resections for CRLM 1992–2004. Primary tumor location determined by chart review (right = cecum to transverse; left = splenic flexure to sigmoid). Rectal cancer (distal 16 cm), multiple primaries, and unknown location were excluded. Kaplan–Meier and Cox regression methods were used. Cure was defined as actual 10-year survival with either no recurrence or resected recurrence with at least 3 years of disease-free follow-up.

Results

A total of 907 patients were included with a median follow-up of 11 years; 578 patients (64%) had left-sided and 329 (36%) right-sided primaries. Median OS for patients with a left-sided primary was 5.2 years (95% confidence interval [CI] 4.6–6.0) versus 3.6 years (95% CI 3.2–4.2) for right-sided (p = 0.004). On multivariable analysis, the hazard ratio for right-sided tumors was 1.22 (95% CI 1.02–1.45, p = 0.028) after adjusting for common clinicopathologic factors. Median RFS was marginally different stratified by primary location (1.3 vs. 1.7 years; p = 0.065). On multivariable analysis, location of primary was not significantly associated with RFS (p = 0.105). Observed cure rates were 22% for left-sided and 20% for right-sided tumors.

Conclusions

Among patients undergoing resection of CRLM, left-sided primary tumors were associated with improved median OS. However, long-term survival and recurrence-free survival were not significantly different stratified by primary location. Patients with left-sided primary tumors displayed a prolonged clinical course suggestive of more indolent biology.
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Metadata
Title
The Impact of Primary Tumor Location on Long-Term Survival in Patients Undergoing Hepatic Resection for Metastatic Colon Cancer
Authors
John M. Creasy, MD
Eran Sadot, MD
Bas Groot Koerkamp, MD
Joanne F. Chou, MD
Mithat Gonen, MD
Nancy E. Kemeny, MD
Leonard B. Saltz, MD
Vinod P. Balachandran, MD
T. Peter Kingham, MD
Ronald P. DeMatteo, MD
Peter J. Allen, MD
William R. Jarnagin, MD
Michael I. D’Angelica, MD, FACS
Publication date
01-02-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 2/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-6264-x

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