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

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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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Acknowledgement

Supported in part by the Biostatistics Core and NIH/NCI P30 CA008748 Cancer Center Support Grant.

Disclosure

None.

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Authors and Affiliations

  1. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    John M. Creasy MD, Eran Sadot MD, Bas Groot Koerkamp 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

  2. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Nancy E. Kemeny MD & Leonard B. Saltz MD

  3. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Joanne F. Chou MD & Mithat Gonen MD

  4. Cornell University, Weill Medical College, New York, NY, 10065, USA

    Michael I. D’Angelica MD, FACS

Authors
  1. John M. Creasy MD
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  2. Eran Sadot MD
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  3. Bas Groot Koerkamp MD
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  10. Ronald P. DeMatteo MD
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  13. Michael I. D’Angelica MD, FACS
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Corresponding author

Correspondence to Michael I. D’Angelica MD, FACS.

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Creasy, J.M., Sadot, E., Koerkamp, B.G. et al. The Impact of Primary Tumor Location on Long-Term Survival in Patients Undergoing Hepatic Resection for Metastatic Colon Cancer. Ann Surg Oncol 25, 431–438 (2018). https://doi.org/10.1245/s10434-017-6264-x

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  • DOI: https://doi.org/10.1245/s10434-017-6264-x

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