A Nationwide Danish Cohort Study Challenging the Categorisation into Right-sided and Left-sided Colon Cancer

Overview

Journal BMJ Open

Specialty General Medicine

Date 2013 Jun 25

PMID 23793665

Citations 55

Authors

Per Jess

Iben Onsberg Hansen

Michael Gamborg

Tine Jess

Affiliations

Soon will be listed here.

Abstract

Objectives: The categorisation of colon cancer (CC) into right-sided (RCC) and left-sided (LCC) disease may not capture more subtle variances in aetiology and prognosis. In a nationwide study, we investigated differences in clinical characteristics and survival of RCC versus LCC and of the complete range of CC subsites.

Design: Prospective nationwide cohort study.

Setting: The database of the Danish Colorectal Cancer Group (DCCG).

Participants: 23 487 CC patients.

Outcome Measures: Overall survival (Kaplan-Meier plots) and mortality (HR from Cox proportional hazards regression analysis) according to CC localisation. For adjustment and stratification, we used age, sex, ASA score (the American Society of Anaesthesiologists score), tumour location and stage, number of lymph nodes harvested at operation, number of lymph nodes with metastases and presence of distant metastases.

Results: Patients with RCC had a higher median age at diagnosis (74.3 years) than patients with LCC (71.8 years; p<0.0001). Overall, the proportion of patients who were women increased the closer the tumour site was to the small intestine. Although RCC patients had higher ASA scores than LCC patients (p<0.0001), the highest ASA scores were observed in patients with cancer in the transverse and descending colon and at both colon flexures. While RCCs overall were more advanced than LCCs (p<0.0001), the most advanced CCs were those of the descending colon, splenic flexure and caecum. RCC mortality was higher than LCC mortality only during the first 2 years (women: HR 1.13; 95% CI 1.06 to 1.20; men: HR 1.27; 95% CI 1.20 to 1.35), and relative to mortality from sigmoid CC, the highest mortality was observed from splenic flexure cancer (HR 1.75; 95% CI 1.54 to 2.00).

Conclusions: The present data challenge the simple categorisation of CC into RCC and LCC.

Citing Articles

Impact of Sidedness of Colon Cancer on Epidemiological, Clinical Presentation, Surgical, Pathological, and Oncologic Outcomes.

Moraes Filho O, Alves Martins B, de Medeiros Silva A, Nobrega Dos Santos A, de Almeida R, Sousa J J Pers Med. 2024; 14(12).

PMID: 39728066 PMC: 11677301. DOI: 10.3390/jpm14121153.

Unexpected right-sided sigmoid colon in laparoscopy: A case report and review of literature.

Hu S, Liu X, Liu H, Hao Y World J Gastrointest Surg. 2024; 16(11):3606-3613.

PMID: 39649208 PMC: 11622073. DOI: 10.4240/wjgs.v16.i11.3606.

Charting the metabolic biogeography of the colorectum in cancer: challenging the right sided versus left sided classification.

Jain A, Morris M, Berardi D, Arora T, Domingo-Almenara X, Paty P Mol Cancer. 2024; 23(1):211.

PMID: 39342363 PMC: 11438248. DOI: 10.1186/s12943-024-02133-5.

Treatment Differences for Splenic Flexure Cancers in Saudi Arabia: A Cross-Sectional Study.

Alotaibi A, Zakariyah A, Malaka A, Alamri M, Aljohani W, Alshehri A Cureus. 2024; 16(7):e63821.

PMID: 39100032 PMC: 11297727. DOI: 10.7759/cureus.63821.

Short- and long-term outcome differences between patients undergoing left and right colon cancer surgery: cohort study.

Kuliavas J, Marcinkeviciute K, Bausys A, Bickaite K, Bausys R, Abeciunas V Int J Colorectal Dis. 2024; 39(1):66.

PMID: 38702488 PMC: 11068684. DOI: 10.1007/s00384-024-04623-w.

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