Nav: Home

Right-sided colon cancer patients have poorer survival than those with left-sided disease

July 23, 2018

ORLANDO (July 23, 2018): Patients with colorectal cancer tumors on the right side may have poorer five-year survival rates than those whose tumors are located on the left side. However, a new large-scale retrospective study is the first to demonstrate a potential improvement of these outcomes. Study results show that nearly doubling the benchmark number of lymph nodes removed during operations for right-sided colon cancers improves the survival rate for these patients, according to researchers who presented these findings at the 2018 American College of Surgeons (ACS) Quality and Safety Conference.

Several studies in recent years have shown that patients with colon cancers on the right side have worse short- and long-term survival rates than those with left-sided tumors regardless of the stage of the disease at diagnosis or the nature of treatment.1 Additional studies have begun to re-examine the surgical management of patients with right-sided colon cancer.2

For years the consensus among professional surgical and cancer treatment societies has held that, at a minimum, 12 lymph nodes should be removed and analyzed to determine the prognosis and treatment of patients with colon cancer on either side. The ACS Commission on Cancer (CoC) has identified this standard as a quality performance indicator for surgical treatment.3 As presented at the ACS conference, these study results are the first to link improved survival with a harvest of more than 20 lymph nodes in the treatment of right-sided cancer.

Investigators from Florida Hospital, Orlando, and McGill University Health Centre, Montreal, Quebec, collected information from the National Cancer Database (NCDB) about patients who underwent surgical removal of the colon for non-metastatic colon adenocarcinoma between 2004 and 2014. After adjusting for patient and disease characteristics as well as the type of systemic treatment, researchers grouped data by tumor location. Of a total of approximately 505,000 patients whose records were entered into the NCDB, 273,200 had right-sided tumors.

Overall five-year survival for this group of patients with right-sided tumors was 66 percent for stage II disease and 56 percent for stage III cancer. In comparison, survival rates were 70 percent and 60 percent for patients with left-sided stage II and III cancers. Among patients with right-sided cancer, the survival rate improved by approximately 20 percent when 22 or more lymph nodes were harvested during patients' operations.

Findings from the study suggest that colorectal surgeons may want to take extra steps to improve lymph node harvest for patients with right-sided disease. Colorectal surgeons from Florida Hospital and McGill University Health Centre are using near-infrared fluorescent scanning to map the lymph node drainage basins around tumors to potentially better identify lymph node metastases.

"We're injecting tumors with indocyanine green dye so we can find suspicious lymph nodes. During surgical resection, we're specifically targeting those extra nodes to get better staging," said study author Lawrence Lee, MD, PhD, a colorectal surgeon and PhD in epidemiology at McGill University Health Centre.

The study also may prompt surgeons to begin reexamining the type of operations they perform on patients with right-sided colorectal tumors.

"Lymph node harvest is related to the extent of the surgical resection. If removal of more lymph nodes improves survival of patients with right-sided cancer, these patients may need a more extensive resection than is considered to be standard for them," Dr. Lee said.

Operations currently differ for left- and right-sided colon cancers. The standard procedure for patients with left-sided cancers involves high central vascular ligation (CVL) of major blood vessels up near the aorta. CVL is not usually done for patients with right-sided cancers because the abdominal anatomy and vascular networks are complicated and operating around them increases operative time and the risk of complications.4

Surgical teams in Asia and Europe have recently reported on small, single-center studies of laparoscopic or robotic extended right-sided resections with CVL that did not increase operative time or complication rate and improved short- and long-term outcomes.5

"The kinds of vascular ligations that are required to get a greater nodal harvest on the right side mean the surgeon is dissecting around really big blood vessels. It's a larger resection overall on that side, and the more vasculature that's involved, the higher the risk for anastomotic breakdown and injury to these blood vessel. So surgeons may not want to do more resection on right-sided colon cancers," said Dr. Lee.

A multicenter, randomized prospective study is required to establish the value of an extended resection and CVL on the right side. As Dr. Lee acknowledged, "We don't know the answer to the risk/reward ratio, but our study shows there's enough of a difference in survival with greater surgical resection that we need a better understanding of the way we're operating on the right side."
Other study investigators include Arman Erkan, MD; Justin J. Kelly MD; George J Nassif, DO, FACS; Matthew R Albert MD, FACS; John RT Monson MD, FACS; from Florida Hospital, and Noura Alhassan MD, from McGill University Health Centre.

Research results were presented at the American College of Surgeons 2018 Quality and Safety Conference in Orlando, Fla., July 21-24, 2018.

"FACS" indicates that a surgeon is a Fellow of the American College of Surgeons.

1 Petrelli F, Prognostic Survival Associated with Left-Sided vs. Right-Sided Colon Cancer. A Systematic Review and Meta-Analysis. JAMA Oncol 2017; 3(2):211-19.

2 Shia J. Lymph Node Staging in Colorectal Cancer: Revisiting the Benchmark of at Least 12 Lymph Nodes in R0 Resection. JACS 2012, 214(3) 348-355.

3 CoC Quality of Care Measures. American College of Surgeons. Available at: Accessed July 2, 2018.

4 Yee LF. What Is a Complete Mesocolic Excision for Colon Cancer. California Pacific Medical Center, Nafziger Society Surgery Day, Mar 7, 2014.

5 Petz W, et al. Suprapubic Approach for Robotic Complete Mesocolic Excision in Right Colectomy: Oncologic Safety and Short-Term Outcomes of an Original Technique. Eur J Surg Oncol, 2017, Nov:43 (11)2060-2066. An MS, et al. Oncological Outcomes of Complete Versus Conventional Mesocolic Excision in Laparoscopic Right Hemicolectomy. ANZ J Surg 2018, Jun 12, doe:10.1111.ans.14493. S Du, et al. A novel and Safe Approach: Middle Cranial Approach for Laparoscopic Right Hemicolon Cancer Surgery with Complete Mesocolic Excision. Surg Endosc 2018 May;32(5):2567-74.

About the American College of Surgeons

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 80,000 members and is the largest organization of surgeons in the world. For more information, visit

About the National Cancer Database (NCDB)

The nationally recognized National Cancer Database (NCDB)--jointly sponsored by the American College of Surgeons and the American Cancer Society--is a clinical oncology database sourced from hospital registry data that are collected in more than 1,500 Commission on Cancer (CoC)-accredited facilities. NCDB data are used to analyze and track patients with malignant neoplastic diseases, their treatments, and outcomes. Data represent more than 70 percent of newly diagnosed cancer cases nationwide and more than 34 million historical records.

American College of Surgeons

Related Cancer Articles:

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.
Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.
Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.
Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.
More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.
New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.
American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.
Oncotarget: Cancer pioneer employs physics to approach cancer in last research article
In the cover article of Tuesday's issue of Oncotarget, James Frost, MD, PhD, Kenneth Pienta, MD, and the late Donald Coffey, Ph.D., use a theory of physical and biophysical symmetry to derive a new conceptualization of cancer.
Health indicators for newborns of breast cancer survivors may vary by cancer type
In a study published in the International Journal of Cancer, researchers from the UNC Lineberger Comprehensive Cancer Center analyzed health indicators for children born to young breast cancer survivors in North Carolina.
Few women with history of breast cancer and ovarian cancer take a recommended genetic test
More than 80 percent of women living with a history of breast or ovarian cancer at high-risk of having a gene mutation have never taken the test that can detect it.
More Cancer News and Cancer Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: Reinvention
Change is hard, but it's also an opportunity to discover and reimagine what you thought you knew. From our economy, to music, to even ourselves–this hour TED speakers explore the power of reinvention. Guests include OK Go lead singer Damian Kulash Jr., former college gymnastics coach Valorie Kondos Field, Stockton Mayor Michael Tubbs, and entrepreneur Nick Hanauer.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Dispatch 6: Strange Times
Covid has disrupted the most basic routines of our days and nights. But in the middle of a conversation about how to fight the virus, we find a place impervious to the stalled plans and frenetic demands of the outside world. It's a very different kind of front line, where urgent work means moving slow, and time is marked out in tiny pre-planned steps. Then, on a walk through the woods, we consider how the tempo of our lives affects our minds and discover how the beats of biology shape our bodies. This episode was produced with help from Molly Webster and Tracie Hunte. Support Radiolab today at