Sided Colon Cancer Research Articles

Outcome of Laparoscopic Resection for Left Sided Colon and Rectal Cancer

Background: For many years, traditional surgery for left colon and rectal cancers had developed with variable degrees of morbidity. With the evolution of laparoscopy and by the aid of better visualization and magnification, laparoscopic colorectal surgery had appeared, but technically challenging as it involves almost all advanced laparoscopic techniques, with the benefits of minimal morbidity, less pain, earlier recovery, shorter hospital stay, without compromising oncological results. Aim: The aim of this work was to evaluate laparoscopic resection for left sided colon and rectal cancer as regard feasibility, safety and outcomes. Patients and Methods: This prospective study was conducted on 40 patients having left sided colon and rectal cancer, including 29 patients with rectal cancer and 11 patients with left sided colon cancer within the inclusion criteria are evaluated by clinical examination, radiological and colonoscopic study and biopsy and treated by laparoscopic resection and followed ranged from 6 months to 2 years with mean of 20 months. Results: Twenty seven patients (67.5%) underwent laparoscopic anterior resection, 11 patients (27.5%) underwent laparoscopic left hemicolectomy and only 2 patients (5%) underwent laparoscopic abdominoperineal resection, minimal morbidity, no cancer related mortality and no recurrence during the period of follow up either local or systemic. Conclusion: Laparoscopic resection for left sided colon and rectal cancer is technically feasible, oncologically safe and has more benefits on postoperative recovery.

Risk Factors for Venous Thromboembolism in Metastatic Colon Cancer Patients in the Contemporary Treatment Era: A SEER-Medicare Data Analysis

Background:The relationship between metastatic colorectal cancer (CRC) and venous thromboembolism (VTE) is not well defined in the modern treatment era. Previous population-based studies date back to a period marked by inpatient intravenous heparin therapy and inferior survival due to paucity of therapeutic anti-cancer options, and before the advent of newer therapies including oxaliplatin, irinotecan, and anti-angiogenic treatment with bevacizumab. The objectives of this retrospective study were to examine the impact of multiple putative risk factors on VTE incidence in a large representative modern cohort of older patients with metastatic CRC.Methods:We performed a retrospective analysis of SEER-Medicare data on elderly patients with metastatic CRC diagnosed in 2004-2011. VTE and associated risk factors were analyzed using multivariate Cox proportional hazards models adjusted for sex, age at diagnosis, race, ethnicity, tumor anatomy (left/right/unknown), calendar year of diagnosis, Charlson comorbidity score, location of SEER registry and urban residence, with time-varying covariates for use of cancer therapies.Results:Of 339,778 records, 11,086 metastatic colon cancer cases were identified. 1,338 cases had VTE with a cumulative incidence of 13% at 1 year and 19% at 3 years. The mean age was 77.9 years (range 65-106). 49.7% were women and 83.5% white. 60.5% had a Charlson comorbidity score of zero at diagnosis; 6% had scores of 6-18.Significant predictors of VTE included female sex (Hazard Ratio (HR) 1.22; 95% Confidence Interval (CI) 1.10, 1.36; P<0.001), younger age at diagnosis (HR 1.25 per decade of age; CI 1.15, 1.37; P<0.001), urban residence (HR 1.20; CI 1.03, 1.40; P=0.02), right sided colon cancers (HR 1.19; CI, 1.06, 1.33 P=0.003), and current use of 5-fluorouracil (HR 1.33; CI 1.04, 1.70; P=0.02). The risk of VTE was significantly reduced when on bevacizumab (HR 0.77; CI 0.63, 0.93; P=.006), or irinotecan therapy (HR 0.59; CI 0.47, 0.75; P<0.001) and in those with more comorbid conditions (HR 0.97 per point of Charlson score; CI 0.935, 0.998; P=0.04).Conclusion: The higher incidence of VTE seen in right sided colon cancers may be related to biologically aggressive tumors associated with poor survival as reported in recent studies. The lower risk of VTE in older, sicker patients was unexpected and may reflect the effect of competing mortality. In this large contemporary cohort, anti-angiogenic therapy was not associated with a higher risk of VTE; the apparent protective effects of bevacizumab and irinotecan may represent treatment assignment bias. DisclosuresNo relevant conflicts of interest to declare.

Insights on colorectal carcinoma based on the biological differences between left-sided and right- sided colon cancers

Previous studies have demonstrated that there are biological differences between colon and rectal cancers. Recently, some authors have proposed that colorectal cancer could be classified into several categories according to the primary sites of the tumor, proximal or distal. It is speculated that the differences are due to different embryologic origin and time to initial diagnosis. Further evidence supports that the molecular differences in the status of K-ras, BRAF, and microsatellite instability (MSI) based on primary sites in the bowel are the basis that impacts the response to therapeutic agents and patient prognosis.

Survival of Resectable Stage II Colon Cancer Patients: Focus on Chemotherapy-Experience from a Single Institution

BackgroundAdjuvant chemotherapy for stage II resectable colon cancer has not been found to impact outcome. Most of the benefit of adjuvant therapy was seen in high-risk stage II disease. We analyzed the survival data from the cancer registry database of our institution to determine the efficacy of adjuvant chemotherapy in stage II colon cancer patients. Materials and MethodsFrom 2007 to 2012, 176 patients with resectable stage II colon cancer were treated at CGH. Overall survival (OS) analysis and sub-group analysis were performed. ResultsMean follow-up was 40.37 months. Survival of stage II colon cancer was superior in patients receiving adjuvant chemotherapy than in those without chemotherapy (p=0.003). Three-year OS was 82% vs. 61% (p=0.004). Survival was better in patients with left side colon cancer receiving chemotherapy (HR 0.093, p=0.002) and in male patients receiving chemotherapy (HR 0.216, p=0.010). ConclusionsBased on our study results, we recommend adjuvant chemotherapy in patients with stage II left side colon cancer in addition to in patients with high risk stage II colon cancer.

Demographics and outcomes of surgically treated right sided colon cancer in India: a 9-year single institution experience.

There is sparse Indian data on right colon cancer. Available literature suggests that it affects the young and survival is poor. This article reviews demographics and outcomes of surgically treated right sided colon cancer over a nine year period in a single colorectal unit in a tertiary care teaching hospital. A retrospective review of all patients undergoing right hemicolectomy for adenocarcinoma of the colon between January 2004 and December 2012 was undertaken. Data was collected from hospital records and telephonic interview when possible. Two hundred and thirteen patients were studied. Mean age was 49 years with 57.1% being 50 years or younger. Stage 1 disease was seen in 9.9%, stage 2 in 35.2%, stage 3 in 42.3%, and stage 4 in 12.7%. Follow up was available for 81.6% with a mean follow up of 35.6 months. Five year disease free survival (DFS) and overall survival (OS) was 81% and 74%. Presence of lymphovascular invasion and age >50 years were predictors of poor survival. Poor prognostic features on histopathology were not different between the young and the old. The 5 year DFS was similar in both, but the 5 year OS was better for the young (90% vs. 73%, p=0.029). Patients with right colon cancer are younger in India. They have similar histopathology when compared to the older population. Operable right colon cancer has an excellent prognosis. Five year DFS is similar in the young and the old, but OS is lower in the older population.

Kras, Braf, PIK3CA and EGFR Gene Mutations are Associated with Lymph Node Metastasis and Right Sided Colon Carcinoma

Mitogen activated proteinase kinase (MAPK) is a key regulator of cellular growth and survival. Mutations in the MAPK pathway genes such as EGFR, KRAS, BRAF and PIK3CA lead to cellular disequilibrium that result into overgrowth and different type of carcinoma including colorectal carcinoma (CRC). Different techniques have been used to determine mutations in the above mentioned genes, and frequency of mutations can vary in different population. The aim of our study was to evaluate the frequency of mutations in the hotspot regions of EGFR, KRAS, BRAF and PIK3CA genes in Swedish colon carcinoma patients by pyrosequencing, and to correlate with different clinicopathological parameters and patient survival. We screened 124 colon cancer patients by using pyrosequencing. We detected Kras, Braf and PIK3CA mutations in 24%, 18.5% and 5.6% of the patients respectively while no mutation was observed for EGFR in our cohort. Kras mutations significantly correlated with lymph node metastasis and advanced UICC stages and poor patient survival (HR; 2.26, 95% CI; 1.273-4.13, log rank P, 0.006). Non-significant correlations were observed between Braf and all parameters including patient survival except with right sided colon cancer. PIK3CA mutations were associated with lymph node metastasis, distant metastasis and higher UICC stages. Combined mutations in Kras, Braf and PIK3CA were significantly associated with lymph node metastasis and colon cancer located on the right flexure. PIK3CA and Kras co-mutations were observed in 4 patients and were significantly associated with lymph node metastasis, distant metastasis and advanced UICC stages.

A suspicious case of postoperative intra-abdominal hemorrhage associated with vitamin K deficiency after the surgery for obstructive left sided colon cancer treated with a self-expanding metallic stent

A suspicious case of postoperative intra-abdominal hemorrhage associated with vitamin K deficiency after the surgery for obstructive left sided colon cancer treated with a self-expanding metallic stent

En bloc Pancreaticodudenectomy with Colectomy for Locally Advanced Right Sided Colon Cancer

A 57 year old male presented to our outpatient clinic with history of on and off melena, weight loss and decreasing appetite for 10 months duration and a noticeable mass on the right upper quadrant. Abdominal examination revealed an intra-abdominal lump in right upper quadrant which was subsequently evaluated by colonoscopy, which revealed an ulcero-proliferative growth in the hepatic flexure and the biopsy from it confirmed well-differentiated adenocarcinoma. Contrast enhanced computed tomography demonstrated hepatic flexure mass with possible invasion into adjacent duodenum without features of advanced disease. After completion of necessary preoperative assessment and investigations, patient was explored with curative intent and underwent extended right hemicolectomy with en bloc pancreaticodudenectomy. Patient was discharged on 10th postoperative day and at 14 months follows up; he was doing well without any evidence of recurrence.

Emergency vs bridge surgery for obstructive right sided colon cancer: multicenter retrospective study

Emergency vs bridge surgery for obstructive right sided colon cancer: multicenter retrospective study

Prevalence of Serrated Adenomas in Non-Hispanic Whites and African Americans Undergoing Screening Colonoscopy

Introduction: Adenomatous polyps are well known as the precursor lesion for colorectal cancer (CRC). However, serrated adenomas/polyps are thought to be a risk factor for the development of proximal and interval colon cancers. African-Americans are at higher risk for the development of right sided colon cancer. Minimal data evaluating serrated adenoma prevalence by race/ethnicity on initial screening colonoscopy exists. The aim of this investigation was to determine the prevalence of serrated adenomas among non-Hispanic whites (nHw) and African Americans (AA) undergoing initial screening colonoscopy at a southern United States safety net hospital. Methods: The University of Florida-Jacksonville endoscopy database was searched for all screening colonoscopies performed between January 1, 2000 and December 31, 2014. Inclusion criteria were nHw or AA race/ethnicity and histologically proven serrated adenoma found at screening colonoscopy. Data collected for all included age at time of colonoscopy, sex and size of serrated adenomas found. Results: A total of 12601 individuals underwent screening colonoscopy between January 1, 2000 and December 31, 2014 of which 8693 individuals were either nHw (4199) or AA (4494). AA undergoing screening colonoscopy were significantly older and noted to have fewer males when compared to nHw (AA 59.9 + 10.16 years old vs nHw 58.7 + 10.32, p < 0.001; AA 40.4% male vs nHw 49.5%, p < 0.001). Serrated adenomas were found in 477 individuals (nHw, N=293; AA, N=184) during the investigation period and AA were less likely than nHw to have serrated adenomas on screening colonoscopy (AA 4.1% vs nHw 7%; p< 0.0001). In those patients where serrated adenomas were diagnosed, 359 (75.3%) were found in the distal colon. No difference was observed in mean age (AA 59.8 + 8.7 years and nHw 59.2 + 8.7 years, p = NS), location (AA 75.5 % distal vs nHw 75.1%, p = NS) or size (nHw 6.6 mm ± 4.2, AA 6.0 ± 4.6, p = NS) between racial/ethnic groups with serrated adenomas. Conclusion: Serrated adenomas are found more frequently in nHw when compared to AA. No difference was seen in the size or location of serrated adenomas between both racial groups. Study of genetic factors predisposing to serrated adenoma formation should be performed across ethnic groups to understand this difference.

Improved survival after an educational project on colon cancer management in the county of Stockholm – A population based cohort study

IntroductionOutcomes in rectal cancer have improved dramatically after the introduction of total mesorectal excision (TME). Recently, the TME concept has been transformed into that of complete mesocolic excision (CME) in an attempt to improve prognosis for patients with colon cancer. Patients and methodsMultidisciplinary team (MDT) workshops including the CME concept were held annually between 2004 and 2008 at the Karolinska University Hospital. The workshops focused on preoperative staging, surgery and histopathology and included lectures and live surgery sessions. To compare survival before and after the “Stockholm Colon Cancer Project” all patients diagnosed with a right sided colon cancer between January 1, 2001 and December 31, 2003 (Group 1) and from January 1, 2006 until December 31, 2008 (Group 2) in Stockholm were identified from the Swedish ColoRectal Cancer Registry (SCRCR). ResultsThe proportion of patients having a tumour resection and the proportion having emergency surgery was higher in Group 1. There were more early tumours and more R0 resections in Group 2. Overall survival in all diagnosed patients and disease free survival after tumour resection was improved in the second time period. DiscussionSurgical teaching programmes may have an impact on the management and outcome in colon cancer. The exact impact from the “Stockholm Colon Cancer Project” cannot be established, however it is likely that it contributed to the improved survival.

Metastatic spread pattern after curative colorectal cancer surgery. A retrospective, longitudinal analysis

ObjectiveThe most common sites of colorectal cancer (CRC) recurrence are the local tissues, liver or lungs. The objective was to identify risk factors associated with the primary CRC tumor and cancer recurrence in these anatomical sites. MethodsRetrospective, longitudinal analyses of data on CRC survivors. Multivariable Cox regression analysis was performed to examine the association between possible cofounders with recurrence to various anatomical sites. ResultsData for 10,398CRC survivors (tumor location right colon=3870, left colon=2898, high rectum=2569, low rectum=1061) were analyzed; follow up time was up to five years. Mean age at curative surgery was 71.5 (SD 11.8) years, 20.2% received radio-chemotherapy, stage T3 (64.4%) and N0 (65.1%) were most common. Overall 1632 (15.7%) had cancer recurrence (Isolated liver n=412, 3,8%; isolated lung n=252, 2,4%; isolated local n=223, 2.1%). Risk factors associated with recurrent CRC were identified, i.e. isolated liver metastases (male: Adjusted Hazard Ratio (AHR) 1,45; colon left: AHR 1,63; N2 disease: AHR 3,35; T2 disease: AHR 2,82), isolated lung metastases (colon left: AHR 1,53; rectum high: AHR 2,48; rectum low: AHR 2,65; N2 disease 3,76), and local recurrence (glands examined<12: AHR 1,51; CRM <3mm: AHR 1,60; rectum high: AHR 2,15; N2 disease: AHR 2,58) (all p values <0001). ConclusionOur study finds that the site of the primary CRC tumor is associated with location of subsequent metastasis. Left sided colon cancers have increased risk of metastatic spread to the liver, whereas rectal cancers have increased risk of local recurrence and metastatic spread to the lungs. These results, in combination with other risk factors for CRC recurrence, should be taken into consideration when designing risk adapted post-treatment CRC surveillance programs.

Abstract 5274: MSI, 18q LOH, and clinicopathological features in stage II sporadic colon cancers: Biomarker study in a phase III study of postoperative adjuvant chemotherapy for stage II colon cancer (SACURA trial)

Abstract Background and Purpose: SACURA trial is a multicenter, randomized phase III study which aims to evaluate the superiority of adjuvant treatment with UFT to observation only after surgery for stage II colon cancer. In an additional translational study, the mRNA expression of 5-FU-related enzymes, MSI and 18q LOH, and histopathological factors including budding are assessed to evaluate correlations with recurrences and survivals. Survival data will be open in 2016. In the present study, we investigated the correlations between clinicopathological features and the status of MSI and 18q LOH to reveal the characteristics of colon cancer in Japan. Material and Methods: From 1038 of 2024 patients enrolled from October 2006 to July 2010, formalin-fixed, paraffin-embedded samples of resected tumors were obtained under informed consent. MSI was evaluated using 5 markers, BAT25, BAT26, D2S123, D5S346, and D17S250 selected from the international guidelines suggested by the National Cancer Institute collaborative meeting. MSI high (MSI-H) was defined as the presence of instability in more than 20% of the markers. Microsatellite stability (MSS) was defined as no unstable marker. 18qLOH was evaluated by 3 markers, D18S69, D18S74E, and D18S851. 18qLOH positivity was defined as the presence of LOH in any of the 18q markers. 18q LOH negativity was strictly defined as the presence of at least two informative markers and the absence of LOH. Each marker were amplified by PCR using fluorescence-labeled primers and analyzed on ABI 3130 Genetic Analyzer using GeneMapper Software Ver. 3.0. Results: Among 1038 tumors, MSI-H was observed in 75 tumors (7.2%). MSI-L and MSS were observed in 24 (2.3%) and 936 tumors (90.5%), respectively. MSI-H was more frequent in female (p = 0.001), right-sided colon cancers (p 5cm tumors (p&amp;lt; 0.0001), poorly-differentiated or mucinous cancers (p&amp;lt; 0.0001), and abnormal CEA (p = 0.004). Age and Depth of tumor invasion had no correlation with MSI status. The 18q LOH phenotype was present in 531 tumors (51.2%) and LOH negativity was observed in 360 (34.7%). Informative LOH data was not available in 147 tumors (14.2%).Tumors with 18q LOH was more frequent in left -sided colon cancers(p&amp;lt; 0.0001) and well to moderately-differentiated cancers (p = 0.008). Age, gender, the tumor size, depth of tumor invasion, and CEA had no correlation with 18q LOH status. Conclusions: This is the first analysis for the status of MSI and 18q LOH in a large population of Japanese colon cancer patients from phase III study. Although the frequency of the MSI phenotype in this study was lower than those in the previous reports from western countries, clinicopathological characteristics of the tumors with MSI and 18q LOH were similar. Our future study in SACURA trial will contribute to establish the prognostic and/or predictive biomarkers in stage II colon cancer. Citation Format: Toshiaki Ishikawa, Hiroyuki Uetake, Megumi Ishiguro, Kenta Murotani, Hideki Ueno, Shigeyuki Matsui, Kenichi Sugihara, Naohiro Tomita, SACURA study group. MSI, 18q LOH, and clinicopathological features in stage II sporadic colon cancers: Biomarker study in a phase III study of postoperative adjuvant chemotherapy for stage II colon cancer (SACURA trial). [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 5274. doi:10.1158/1538-7445.AM2015-5274

Cholecystectomy and the risk of alimentary tract cancers: a systematic review.

To investigate the association between cholecystectomy and gastro-intestinal tract (GIT) cancers. We conducted a systematic review according to the PRISMA guidelines. A MEDLINE search was performed with predefined search criteria for English Language articles on the association between cholecystectomy and GIT cancers. Additional articles were retrieved by manual search of references. All relevant articles were accessed in full text. Data on study type; cases; controls; country; effect estimate; adjustments for confounders and quality of publication were extracted. The quality of the publications were scored by adherence to the STROBE checklist. The data for each part of the GIT were presented in separate tables. Seventy-five studies and 5 meta-analyses satisfied the predefined criteria for inclusion and were included in this review. There were inconsistent reports and no strong evidence of an association between cholecystectomy and cancers of the oesophagus (Adenocarcinoma), pancreas, small bowel and right-sided colon cancers. In squamous cancer of the oesophagus, cancers of the stomach, liver, bile ducts, small bowel and left sided colon cancers, good quality studies suggested a lack of association with cholecystectomy. Equally, distal colon and rectal cancers were found not to be associated with cholecystectomy. Several mechanisms for carcinogenesis/promotion of carcinogensis have been proposed. These have focused on a role for bile salts in carcinogenesis with several potential mutagenic molecular events and gut metabolic hormones signaling cell proliferation or initiation of carcinogenesis. This is a comprehensive review of the association between GIT cancers and cholecystectomy. This review found no clear association between cholecystectomy and GIT cancers.

Comparison of veterans diagnosed with left and right colon cancer over a period of 10 years.

e14616 Background: We studied the characteristics and survival for patients (pts) with left and right sided colon cancer in Veterans. Methods: In an IRB-approved protocol, we reviewed the records o...

WNT signaling and distant metastasis in colon cancer through transcriptional activity of nuclear β-Catenin depend on active PI3K signaling.

We determined whether active PI3K signaling together with nuclear accumulation of β-Catenin is necessary to fully activate canonical WNT signaling and examined the association of both signaling pathways with colon cancer progression. Using reporter gene assays we examined the activation of β-Catenin mediated transcription upon PI3K inhibition with or without β-Catenin nuclear accumulation. Ectopically induced as well as constitutively active WNT signaling strictly required PI3K activity whereas PI3K inhibition had no effect on β-Catenin subcellular localization but impaired β-Catenin binding to WNT target gene promoters and decreased WNT target gene expression. Transcriptional activity of nuclear β-Catenin depended on active PI3K signaling as nuclear accumulation of β-Catenin failed to induce WNT reporter gene transcription upon PI3K inhibition. PI3K dependend transcriptional transactivation of β-Catenin relies on events beyond phosphorylation at the AKT target site serine 552, as S552D-phosphomimetic β-Catenin mutants were unable to restore WNT signaling when inhibiting PI3K. To study the prognostic value of PI3K pathway activation (activating PIK3CA mutations or loss of PTEN expression) and nuclear β-Catenin expression, both variables were determined in 55 matched pairs of primary right sided colon cancer cases with or without distant metastasis. Activating mutations in the PIK3CA gene or loss of PTEN expression did not correlate with distant metastasis while high nuclear β-Catenin expression combined with activation of the PI3K pathway identified cases in which distant metastasis had occurred. Activation of the PI3K pathway was not associated with nuclear β-Catenin expression. We conclude that the transcriptional activity of nuclear β-Catenin depends on PI3K activity. However, PI3K on its own does not affect β-Catenin subcellular localization. Both factors synergize for full WNT signaling activity and are associated with distant metastasis in colon cancer. Thus, the detection of high nuclear β-Catenin expression and simultaneous PI3K pathway activation identifies colon cancer patients with a high risk for distant metastasis.

Clinicopathological Features of Colon Adenocarcinoma in Qazvin, Iran: A 16 Year Study

Colorectal cancer (CRC) was the fourth most commonly diagnosed cancer in Iran between 2000 and 2009, with adenocarcinoma (AC) as the most common histological type. Demographic, topographic and histological variables are important in the epidemiology and biology of cancer. The aim of this study was to investigate clinicopathological features of colon adenocarcinomas in Qazvin, Iran. With a retrospective design, patient records of two pathology wards from March 1997 to March 2013 were studied with regard to anatomical location and histological classification. A broader anatomical grouping was also used including distal vs proximal regions and right sided vs left sided tumors. Data were analyzed using T-test and chi-square test. 118 (50.9%) male and 114 (49.1%) female patients were included in the study. Mean age was 57.3±14.7 years, with 29.2% under 50 years. There was no significant gender difference for age at diagnosis. The rectum (56%) and sigmoid colon (25%) were the most frequent anatomical locations. Proximal cases accounted for 18.6% in males and 8.8% in females (p=0.02). AC was more prevalent than other usual types in younger patients. The proportion of proximal cancer was 1.7% in first eight years of the study period vs 12.1% in the second one (p=0.005). A similar trend was also seen in right sided colon cancers (p=0.018). Young people are also at risk for the cancer with poor prognosis. Screening programs and weight loss in obese individuals can reduce incidence and complications of CRC.

Reply on "data on the characteristics and the survival of korean patients with colorectal cancer from the Korea central cancer registry".

To the editor Thank you for great interest to our article. Your comment has persuaded me to make a further analysis. I agree with your mention about difference of tumor distribution between Korea and Europe/America. The Korean patients showed a lower proportion of right sided colon cancer than European and American patients, which may represent geographical differences [1]. I would like to comment to stage distribution and survival. Recent report in America about stage distribution demonstrated that only 39% of colorectal cancer patients had localized-stage disease and about 34%-41% had regional disease, which was somewhat different to your table. They also reported that the 5-year relative survival in localized disease was 90%, and survival diagnosed at the regional and distant stage were 70% and 12%, respectively [2]. Nevertheless, Korean patients showed favorable survival. The intensive treatment and surveillance system under the national medical insurance may influence on this finding. For example, most Korean patients (more than 80%) in regional disease received adjuvant chemotherapy after surgery. Introduction of adjuvant chemotherapy was associated with improved survival in stage III colon cancer [3]. In addition, we included colorectal cancer patients recently developed; therefore, it may influence on favorable survival. Survival of colorectal cancer has improved in Europe and America [4, 5].

Flexible sigmoidoscopy alone for right sided colon cancer with colorectal symptoms

Flexible sigmoidoscopy alone for right sided colon cancer with colorectal symptoms

Survival after Complete Mesocolic Excision (CME) for Right Sided Coloncancer Compared to Standard Surgery

Purpose: Complete mesocolic excision for right sided colon cancer is a complex operation that might offer a survival benefit. However, studies comparing CME to standard surgery have not been published so far. Methods: One-hundred-seven patients were operated at the discretion of the surgeon either according to principles of complete mesocolic excision (CME-group, n=69) or received a standard right hemicolectomy (non-CME group, n=38). The type of surgery was prospectively recorded. Results: Patients in the non-CME group were significantly older (67,9 vs.78,1 p<0,001) and had fewer adjuvant chemotherapies in stage III (94,7 vs. 60,0% p=0,02). For the combined analysis of stages I-III actuarial 5-year overall-, recurrence free- and tumor specific survival was significantly better for the CME group (OS 89,4% vs. 71,5%, p=0,011; RFS 83,8% vs. 70,3% p=0,035; TSS 93,8% vs. 78,0% p=0,049). Conclusion: The data suggest a survival benefit for complete mesocolic excision in the treatment of right sided colon cancer. However, the data needs to be interpreted with caution because of the uneven distribution of age and number chemotherapies. The results of the large multicentre trial which is currently going on among German certified cancer is expected to further clarify this issue.