title: The prognostic implications of primary colorectal tumor location on recurrence and overall survival in patients undergoing resection for colorectal liver metastasis.
abstract: OBJECTIVE
  The prognostic impact of primary colorectal cancer (CRC) location following resection of colorectal liver metastasis (CRLM) remains largely unknown. We sought to characterize the prognostic implications of primary tumor location among patients who underwent curative-intent hepatectomy for CRLM.
  
  
  METHODS
  Tumors of the cecum, ascending, and transverse colon were defined as right-sided; tumors of the sigmoid flexure, descending, and sigmoid colon were defined as left-sided. Clinicopathologic and long-term survival data were collected and assessed using univariable and multivariable analyses.
  
  
  RESULTS
  About 475 patients who underwent CRLM resection at a single institution were included; most patients had left-sided tumors (n = 284). Median and 5-year RFS was 20.2 months and 28.0%, respectively. Patients who had a left-sided primary tumor had a shorter RFS compared with patients who had a right-sided tumor (P = 0.01). Although site of and time to recurrence did not differ between the two groups (P > 0.05), patients with right-sided primary tumors were more likely to recur with advanced disease (i.e., ≥4 recurrent lesions) (P < 0.01). In turn, patients with right-sided tumors had both worse OS (P = 0.03) and worse survival after recurrence (P = 0.01).
  
  
  CONCLUSIONS
  While patients with right-sided tumors experienced longer RFS, when these patients did recur following CRLM resection, disease extent was more advanced. In turn, OS following recurrence was shorter among patients with right-sided CRC. J. Surg. Oncol. 2016;114:803-809. © 2016 2016 Wiley Periodicals, Inc.
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Kazunari
authors: K
authors: Sasaki
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Nikolaos
authors: N
authors: Andreatos
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Georgios A
authors: GA
authors: Margonis
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Jin
authors: J
authors: He
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Matthew
authors: M
authors: Weiss
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Fabian
authors: F
authors: Johnston
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Christopher
authors: C
authors: Wolfgang
authors: Second, Department of Propaedeutic Surgery, Laiko Hospital, University of Athens, Athens, Greece.
authors: Efstathios
authors: E
authors: Antoniou
authors: First Department of Surgery, Laiko Hospital, University of Athens, Athens, Greece.
authors: Emmanouil
authors: E
authors: Pikoulis
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. tpawlik1@jhmi.edu.
authors: Timothy M
authors: TM
authors: Pawlik
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis
keywords: CRC; CRLM; left-sided; location; prognosis; right-sided