Annals of Surgical Oncology

, Volume 20, Issue 13, pp 4161–4168 | Cite as

Survival After Resection of Colorectal Cancer Based on Anatomical Segment of Involvement

  • Aneel Bhangu
  • Ravi P. Kiran
  • Alistair Slesser
  • J. Edward Fitzgerald
  • Gina Brown
  • Paris TekkisEmail author
Colorectal Cancer



To determine survival differences for patients undergoing colonic or rectal resection for cancer on the basis of the specific anatomical location of primary tumor.


A total of 143,747 patients undergoing segmental colectomy, hemicolectomy, anterior resection, or abdominoperineal resection (APER) for adenocarcinoma from 1995 to 2009 were identified from 13 Surveillance, Epidemiology, and End Results regions. The primary end point was overall survival determined by adjusted hazard ratios (HRs); the secondary end point was lymph node yield.


Total lymph node yield significantly decreased from proximal to distal resected segment in stage 0–II cancer, but not in stage III cancer. Lymph node ratio increased from cecum to hepatic flexure and then decreased distally (p < 0.001). Adjusted HRs revealed that survival after right colonic resection for ascending hepatic flexure and transverse colon cancer was not significantly different from cecal cancer. Survival after left colonic resection for descending colon cancer was not different from splenic flexure cancer, but sigmoid colectomy carried improved survival (HR 0.95, p = 0.027). APER carried worse survival compared to anterior resection (HR 1.28, p < 0.001) or right colonic resection for cecal cancer (HR 1.61, p < 0.001).


Survival after resection from colorectal cancer depends on specific anatomical segment and not just the division between colon and rectum, or left and right colon. This may be related to inherent differences in the anatomical characteristics of the particular colorectal segment, with varying lymph node yields contributing to understaging. This supports an individualized approach to colorectal cancer, with particular attention to surgical technique, leading to survival improvement.


Anterior Resection Colonic Resection Splenic Flexure Complete Mesocolic Excision Transverse Colon Cancer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors declare no conflict of interest.

Supplementary material

10434_2013_3104_MOESM1_ESM.docx (88 kb)
Supplementary material 1 (DOCX 88 kb)


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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Aneel Bhangu
    • 1
    • 2
  • Ravi P. Kiran
    • 3
  • Alistair Slesser
    • 1
    • 2
  • J. Edward Fitzgerald
    • 1
    • 2
  • Gina Brown
    • 4
  • Paris Tekkis
    • 1
    • 2
    Email author
  1. 1.Department of Colorectal SurgeryRoyal Marsden HospitalLondonUK
  2. 2.Division of SurgeryImperial CollegeLondonUK
  3. 3.Division of Colorectal SurgeryNew York Presbyterian Hospital, Columbia University Medical CenterNew YorkUSA
  4. 4.Department of RadiologyRoyal Marsden HospitalLondonUK

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