The side of the primary tumor affects overall survival in colon adenocarcinoma: an analysis of the national cancer database

  • M. C. TurnerEmail author
  • D. Becerra
  • Z. Sun
  • J. Watson
  • K. Leung
  • J. Migaly
  • C. R. Mantyh
  • D. G. Blazer
Original Article



Due to conflicting study results on the effect of laterality on overall survival in primary colon cancers, we sought to examine the impact of left compared to right-sided primary tumors on overall survival for stage I–III colon cancer using the largest dataset to date.


The 2006–2013 NCDB was queried for patients with single primary, stage I–III colon adenocarcinoma and grouped by stage and tumor location.


For stage I–II tumors, 114,839 patients had resection (62% right:38% left). After adjustment, patients with right-sided tumors had superior survival ([HR right as reference]: 1.13, 95% CI 1.09–1.17, p < 0.001). For stage III tumors, 71,024 patients had resection, (59% right:41% left). After adjustment, patients with left-sided tumors had superior survival with chemotherapy (HR 0.85, p < 0.001) and no difference in survival without chemotherapy (HR 0.97, p = 0.18).


The side of the primary tumor impacts overall survival across stages for colon adenocarcinoma. Patients with right-sided tumors have superior survival for stage I–II disease while patients with left-sided stage III disease demonstrate a survival advantage, suggesting an opportunity for investigators to use sidedness as a surrogate for prognosis and chemoresponsiveness.


Colon adenocarcinoma Overall survival Sidedness Left versus right Chemotherapy Surgery 


Author contributions

All the authors have approved the final manuscript. MCT was responsible for concept generation, data acquisition, statistical analysis, data interpretation, manuscript writing, revisions and submission. DB was responsible for data interpretation, manuscript writing, and manuscript revisions. ZS was responsible for concept generation, data acquisition, statistical analysis, data interpretation, and manuscript revisions. KL was responsible for concept generation, data interpretation, and manuscript revisions. JW was responsible for data interpretation, manuscript writing, revisions and submission. JM was responsible for concept generation, data acquisition, data interpretation, and manuscript revisions. CRM was responsible for concept generation, data acquisition, data interpretation, and manuscript revisions. DGB was responsible for concept generation, data interpretation, and manuscript revisions and provided study oversight.


This project was performed using departmental funds and received no external funding.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.

Ethics approval and consent to participate

This study was granted exempt status by the Duke Institutional Review Board given the de-identified nature of the dataset.

Informed consent

Informed consent was not performed in this setting.

Availability of the data and material

The data were acquired by application through the National Cancer Database (NCDB). The statistical analysis was performed in R (Vienna, Austria). The NCDB is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The data used in this study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigators.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • M. C. Turner
    • 1
    • 2
    Email author
  • D. Becerra
    • 1
  • Z. Sun
    • 1
  • J. Watson
    • 1
  • K. Leung
    • 1
  • J. Migaly
    • 1
  • C. R. Mantyh
    • 1
  • D. G. Blazer
    • 1
  1. 1.Department of SurgeryDuke University Health SystemsDurhamUSA
  2. 2.Duke University Medical CenterDurhamUSA

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