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Right-sided colon cancer and left-sided colorectal cancer have significant differences in epidemiology,clinical features,tumor differentiation,response to treatment,prognosis,and molecular characteristics.The former has lower prevalence than the latter and is mainly associated with female and elderly patients,with poor tumor differentiation,strong invasion,poor prognosis,and weak response to epidermal growth factor receptor inhibitors.Thus,it is generally believed that the primary location of colorectal cancer is closely associated with prognosis,acting as an independent prognostic factor for therapeutic efficacy.Recent studies have revealed the genetic differences between right-sided colon cancer and left-sided colorectal cancer,providing explanations for the biological differences.This review summarizes the recent advances on the differences between left-and right-sided colorectal cancer.
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Aged , Female , Humans , Colorectal Neoplasms/genetics , PrognosisABSTRACT
ABSTRACT Objectives: Different clinicopathological and molecular features have been demonstrated between right and left sided colon cancers. We aimed to characterize colon cancer and sidedness among a North-Pakistani rural population diagnosed with colon cancer in our institution. Methods: Seventy patients were included in the study that received adjuvant chemotherapy at Bannu Institute of Nuclear Medicine Oncology and Radiotherapy) Bannu, Pakistan from January 2014 to December 2017. Chi-square test was used for significance of categorical variables. p-Values less than 0.05 were considered significant. Results: Mean age at diagnosis for right side colon cancer patients was 43.94 years and for left side colon cancer, it was 49.83 with no significant difference. Male patients were presented more with right (77% vs. 54%, p = 0.044) and females with predominantly left sided tumours i.e. (46% vs. 23%, p = 0.044). Right sided cancer tended to be more poorly differentiated (20% vs. 0%, p = 0.020). Mucinous adenocarcinoma was seen mostly in right sided colon cancer (37% vs. 3%, p ≤ 0.001). There were more locally advanced presentation of right side colon cancer with more node positive (83% vs. 60%, p = 0.025) and lymphovascular invasion (51% vs. 37%, p = 0.016). Sigmoid colon was the most common tumour subsite involved. Conclusion: Our study is the first report of colon cancer in a rural population in North-Pakistan. An earlier onset of tumours (44-50 years) was observed in comparison with global data.
RESUMO Objetivo: Características clínico-patológicas e moleculares distintas foram observadas em tumores de cólon no lado direito ou esquerdo. O presente estudo teve como objetivo caracterizar o câncer de cólon e sua lateralidade em uma população rural norte-paquistanesa diagnosticada com câncer de cólon nesta instituição. Métodos: O estudo incluiu 70 pacientes que foram submetidos a quimioterapia adjuvante no Instituto Bannu de Medicina Nuclear Radioterapia Oncológica (BINOR), Bannu, Paquistão, entre janeiro de 2014 e dezembro de 2017. O teste qui-quadrado foi utilizado para mensurar a significância das variáveis categóricas. Valores de p menores que 0,05 foram considerados significativos. Resultados: A média de idade ao diagnóstico entre pacientes com câncer de cólon no lado direito foi de 43,94 anos e entre aqueles com câncer de cólon no lado esquerdo, 49,83, sem diferença significativa. Os pacientes do sexo masculino apresentaram mais tumores no lado direito (77% vs. 54%, p = 0,044) e as pacientes do sexo feminino apresentaram mais tumores no lado esquerdo (46% vs. 23%, p = 0,044). Tumores mal diferenciados foram mais comumente observados no lado direito (20% vs. 0%, p = 0,020). Adenocarcinoma mucinoso foi observado principalmente em casos de tumores no lado direito (37% vs. 3%, p ≤ 0,001). A apresentação local estava mais avançada em tumores de cólon no lado direito, com mais linfonodos positivos (83% vs. 60%, p = 0,025) e invasão linfovascular (51% vs. 37%, p = 0,016). O cólon sigmoide foi o sublocal mais comum. Conclusão: O presente estudo é o primeiro relato de câncer de cólon em uma população rural no norte do Paquistão. Em comparação com dados globais, observou-se um surgimento mais precoce dos tumores (44-50 anos).
Subject(s)
Humans , Male , Female , Colonic Neoplasms/diagnosis , Colonic Neoplasms/pathologyABSTRACT
@#[Abstract] Objective: To compare the differences in clinical and pathological features and survival time between patients with left -sided colon cancer and rectal cancer. Methods:Atotal of 323 patients with colorectal cancer (CRC) underwent surgical resection at Changhai Hospital of the Second Military Medical University between January 2011 and January 2012 were enrolled in this study. The clinical data of patients were collected and the follow-up was started from the day of surgery or pathological confirmation with the death of patients as endpoints. The follow-up lasted untilAugust 1,2017. Results: There were significant differences in initial symptoms, pathologic type, tumor stage, anemia before surgery, p53 positive rate, and BRAF mutation (χ2=59.088， 4.188， 24.305， 11.956， 4.221， 4.001， all P<0.05) between patients with left-sided colon cancer and rectal cancer. For all the patients, the median survival time was not observed. The five-year survival rates of patients with left-sided colon cancer and rectal cancer were 79.2% and 74.3%, respectively. The Kaplan-Meier survival curves of patients at StageⅠ-Ⅱshowed that there was no statistical difference between patients with left-sided colon cancer and rectal cancer（P=0.840） and the survival of Stage Ⅲ patients between the two groups also showed no statistical difference (P=0.106). Cox regression analysis showed that both the pathologic types [HR=1.759, P=0.047] and tumor stage [HR=2.104, P<0.001] were independent predictive factors for OS of CRC patients. Conclusion: There were no differences in survival time between patients with left-sided colon cancer and rectal cancer. The pathologic types and tumor stage were factors influencing the OS of CRC patients.
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Objective: To investigate the prognostic factors of patients with stages I-III left-sided colon cancer (LCC) versus right-sided colon cancer (RCC) receiving radical surgery. Methods: A retrospective analysis of clinical data from 332 patients with stages I-III colorectal cancer (CRC) who underwent radical surgery in Anhui Provincial Hospital, Anhui Medical University between February 2008 and February 2012 was conducted. The differences in clinicopathological characteristics by tumor location (RCC vs LCC) were examined by using χ2 test. The comparisons of overall 5-year survival rate between RCC and LCC within each stage and for all stages were done by using Kaplan-Meier method. The univariate analysis of prognosis was performed by using log-rank test, and the multivariate analysis was performed by using COX regression model. Results: The overall 5-year survival rate of all patients was 69.9%. The LCC patients had significantly higher overall 5-year survival rate than RCC patients (72.6% vs 66.9%, P = 0.020). The stage III LCC patients had significantly higher overall 5-year survival rate than the stage III RCC patients (62.5% vs 52.2%, P = 0.018), but no significant difference in overall 5-year survival rate was found between stage I or II RCC and LCC patients (P > 0.05). There were significant differences in T stage, histologic type, degree of differentiation, tumor size, hemoglobin, albumin, fibrinogen and carcinoembryonic antigen (CEA) between RCC and LCC patients (all P < 0.05). The univariate analysis showed that tumor location, T stage, N stage, histologic type, degree of differentiation, tumor size, hemoglobin, albumin, fibrinogen and CEA were significantly correlated with overall 5-year survival rate of CRC patients (all P < 0.05). Multivatiate analysis showed that N stage, histologic type, degree of differentiation, hemoglobin, albumin, fibrinogen and CEA were independent prognostic factors of CRC (all P < 0.05). Conclusion: For patients with stages I-III CRC treated with radical surgery, the factors of higher tumor N stage, mucinous adenocarcinoma/signet ring cell carcinoma, poorly differentiated carcinoma, anemia, hypoproteinemia, fibrinogen level more than 4 g/L and CEA level more than 10 ng/mL indicate a poor prognosis. The significant differences in clinicopathological characteristics and prognosis are found between RCC and LCC, but the tumor location is not an independent prognostic factor.
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PURPOSE: Laparoscopic surgery for left-sided colon cancer is one of the most frequent procedures performed in laparoscopic colorectal surgery. In this study, we analyzed clinical and long-term oncological outcomes of left-sided colon cancer patients who underwent conventional laparoscopic surgery (CLS) and hand-assisted laparoscopic surgery (HALS).METHODS: A total of 172 CLS patients and 72 HALS patients for left-sided colon cancer from July 2001 to December 2011 were included in this study. The collected data included the clinical and oncological outcomes. We analyzed overall survival and disease-free survival by tumor, node, metastasis (TNM) stage.RESULTS: The mean age of the patients was 64 years, and male patients were predominant. The mean follow-up period was 58.1 months. The number of patients that belong in each TNM stage 0, I, II, III, and IV was as follows: 17 (7%), 47 (19.2%), 70 (28.7%), 80 (32.8%), and 30 (12.3%), respectively. Overall 5-year survival rate for TNM stage I, II, III, and IV was 87.1%, 82.8%, 82%, and 12%, respectively. Overall 5-year survival rate for CLS group and HALS group was 90.2% and 66.7%, 86.5% and 77%, 88.7% and 67.4%, and 18.9% and 0%, respectively. Disease-free 5-year survival rate for TNM stage I, II, and III was 97.7%, 90.7%, and 72.8%, respectively. Disease-free 5-year survival rate for CLS group and HALS group was 97.3% and 100%, 100% and 78.8%, and 81% and 55.1%, respectively.CONCLUSION: These data show the feasibility and safety of laparoscopic surgery for left-sided colon cancer in terms of long-term oncological outcomes.
Subject(s)
Humans , Male , Colon , Colonic Neoplasms , Colorectal Surgery , Disease-Free Survival , Follow-Up Studies , Hand-Assisted Laparoscopy , Laparoscopy , Neoplasm Metastasis , Survival RateABSTRACT
Colorectal cancer is one of the most common malignancies. Various studies have focused on differences between colon can-cers on the left and right sides. These types of colon cancer differ in terms of their molecular features, embryologic origin, anatomy, pathogenesis to physiological functions, clinical features, treatment response, and prognosis. Therefore, the left-and right-side colon cancers are regarded as different diseases. These differences have significant effect on clinical decision-making and personalized medi-cine.
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In recent years, the incidence and mortality of colorectal cancer have gradually increased in China. This review sum-marized the differences in pathogenic factors, clinical manifestations, pathological features, gene expression, therapeutic modalities, and other aspects between left-and right-sided colon cancers. Results showed that the onset of both left-and right-sided colon cancers is associated with gender and age. Significant differences existed among the clinical manifestations and pathological features. Differenc-es in gene expression, allelic deletion, and DNA mismatch repair affected the occurrence, metastasis, and prognosis of left-and right-sided colon cancers. Moreover, the location of primary tumor is a potential predictor of targeted drug efficacy. Differences in survival rates are possibly related to TNM stage. Hence, new ideas for individualized treatment should be provided by analyzing the differences between left-and right-sided colon cancers.
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Objective To provide molecular genetic basis for oncobiological difference in left sided colon cancer and right sided colon cancer. Differentially expressed proteins in left sided colon cancer and right sided colon cancer were screened by proteomic technique. Methods Tissue samples including left sided colon cancer and right sided colon cancer were collected and preserved in the -80℃ refrigerator. In the first part of our experiment, protein was separated by 2-dimensional gel electrophoresis (2-DE) and the images of the gels were acquired by the scanner and then analyzed to find the differentially expression protein-spots in different groups. The peptide mass fingerprintings (PMF) was acquired by matrix assisted laser desorptiorn/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) and the proteins were identified by data searching in the Mascotdatabase. Differentially expressed proteins were assayed by RT-PCR, Western blot, and immunohistochemical method. Results Altogether 55 differentially expressed protein spots were screened and 21 spots of them were identified. Compared with the right sided colon cancer, 14 proteins were up-regulated and 7 proteins down-regulated including HSP27 in the left sided colon cancer. HSP27 expressed higher in the right sided colon cancer than in the left sided colon cancer.Conclusion There are differentially expressed proteins in left sided colon cancer and right sided colon cancer, especially difference in HSP27 expression at mRNA and protein level, which may be molecular genetic basis for oncobiological difference in left sided colon cancer and right sided colon cancer.
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PURPOSE: Laparoscopic surgery has been considered to be contraindicated for treating malignant colorectal obstruction. Stent insertion for obstructive colorectal cancer has recently allowed laparoscopic surgery to be performed by means of preoperative bowel decompression and bowel preparation. The aim of this study is to evaluate the safety and the feasibility of a one-stage laparoscopic resection for obstructive left-sided colon cancer after stent insertion by comparing the results to those for non-obstructive left-sided colon cancer. METHODS: Between May 2006 and January 2009, a laparoscopic colorectal operation was performed on 18 consecutive patients with obstructive left-sided colon cancer after placement of a self-expandable stent by one colorectal surgeon, and the results were compared retrospectively to those for 43 patients with non-obstructive left-sided colon cancer who had undergone a laparoscopic procedure with the same surgeon. The collected data were the clinicopathologic characteristics, the perioperative complications, the oncologic outcomes, the postoperative recovery results, and the survival rate. RESULTS: The obstructive left-sided colon cancer group had significant benefits in retrieved lymph nodes (18.8+/-5.3 vs. 14.0+/-8.7, P=0.036), and distal resection margin (5.5+/-3.0 cm vs. 3.6+/-2.4 cm, P=0.011). There were no significant differences in other clinicopathological characteristics and oncologic outcomes, including the overall 3-yr survival rate, between the two groups. CONCLUSION: Preoperative stent decompression followed by a laparoscopic colorectal resection is a safe and feasible option for treating obstructive left-sided colon cancer. A further large-scale prospective study should be performed to evaluate the long-term outcome of a one-stage laparoscopic resection using stent insertion in cases of obstructive left-sided colon cancer.
Subject(s)
Humans , Colon , Colonic Neoplasms , Colorectal Neoplasms , Decompression , Laparoscopy , Lymph Nodes , Retrospective Studies , Stents , Survival RateABSTRACT
Surgical treatment of acute malignant obstruction of the left colon is problematic due to the poor general state of patients, lack of bowel preparation, and the urgency of the procedure itself. A multistage approach including emergent diverting colostomy has traditionally been the method of surgical treatment for acute left sided colonic obstruction secondary to the tumor. However, these treatment efforts have been marred by an inability to complete the sequence of operations due to numerous medical co-morbidities in the patients. The use of a self expanding metallic stent to relieve colorectal malignant obstruction has been recently, described for the palliative purpose of relieving the obstruction and for converting emergency surgery into elective surgery following routine preoperative bowel preparation. Either a covered or uncovered expandable colorectal stent (Choo colorectal endoprosthesis; Sooho Medi-Tech, Seoul, Korea) was inserted by endoscopic and fluoroscopic guidance in 6 patients with acute malignant left-sided colonic obstruction. We present these 6 patients who underwent self expandable metallic stent insertion for the treatment of left sided malignant colonic obstruction as a bridge to a single operation.