The prognostic relevance of primary tumor sidedness to surgical treatment for recurrent colon cancer



The aim of this study was to investigate the predictive relevance of tumor sidedness on surgical resection after recurrence by evaluating the treatment outcomes after primary resection and recurrence in patients with localized colon cancer (CC).


A total of 735 consecutive patients who underwent curative resection for Stage I–III CC from 1997 to 2013 were categorized as having either right- or left-sided CC, and survival after primary surgery and after recurrence were analyzed.


A total of 104 patients (14.1%) developed recurrence, 94 of which were in a single organ, and 59 patients underwent curative resection. For recurrence from both sides of the colon, a significantly better 5-year overall survival (OS) was experienced by patients who underwent curative resection compared to those who received palliative treatment (right: 42.2% vs not reached, respectively; P < 0.001; left: 71 vs 15.9%, respectively; P < 0.001). Meanwhile, a still worse OS was observed in patients with curative resection for recurrent right-sided CC compared to those with resection for recurrent left-sided CC (5-year: 42.2 vs 71%; P = 0.03).


Surgical resection undoubtedly improved survival after recurrence, however, patients with surgical resection for recurrent right-sided CC tended to have a worse prognosis.

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  1. 1.

    Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–386.

    CAS  Article  Google Scholar 

  2. 2.

    Brenner H, Kloor M, Pox CP. Colorectal cancer. Lancet (London, England). 2014;383(9927):1490–502.

    Article  Google Scholar 

  3. 3.

    Taieb J, Kourie HR, Emile JF, Le Malicot K, Balogoun R, Tabernero J, et al. Association of prognostic value of primary tumor location in stage III colon cancer with RAS and BRAF mutational status. JAMA Oncol. 2018;4(7):e173695.

    Article  Google Scholar 

  4. 4.

    Petrelli F, Tomasello G, Borgonovo K, Ghidini M, Turati L, Dallera P, et al. Prognostic survival associated with left-sided vs right-sided colon cancer: a systematic review and meta-analysis. JAMA Oncol. 2016.

  5. 5.

    Shen H, Yang J, Huang Q, Jiang MJ, Tan YN, Fu JF, et al. Different treatment strategies and molecular features between right-sided and left-sided colon cancers. World J Gastroenterol. 2015;21(21):6470–8.

    CAS  Article  Google Scholar 

  6. 6.

    Venook AP, Niedzwiecki D, Innocenti F, Fruth B, Greene C, O'Neil BH, et al. Impact of primary (1º) tumor location on overall survival (OS) and progression-free survival (PFS) in patients (pts) with metastatic colorectal cancer (mCRC): analysis of CALGB/SWOG 80405 (Alliance). J Clin Oncol. 2016;34(15_suppl):3504–3504.

    Article  Google Scholar 

  7. 7.

    Tejpar S, Stintzing S, Ciardiello F, Tabernero J, Van Cutsem E, Beier F, et al. Prognostic and predictive relevance of primary tumor location in patients with RAS wild-type metastatic colorectal cancer: retrospective analyses of the CRYSTAL and FIRE-3 trials. JAMA Oncol. 2017;3(2):194–201.

    Article  Google Scholar 

  8. 8.

    Loupakis F, Yang D, Yau L, Feng S, Cremolini C, Zhang W, et al. Primary tumor location as a prognostic factor in metastatic colorectal cancer. Journal of the National Cancer Institute 2015;107(3).

  9. 9.

    Arnold D, Lueza B, Douillard JY, Peeters M, Lenz HJ, Venook A, et al. Prognostic and predictive value of primary tumour side in patients with RAS wild-type metastatic colorectal cancer treated with chemotherapy and EGFR directed antibodies in six randomized trials. Ann Oncol. 2017;28(8):1713–29.

    CAS  Article  Google Scholar 

  10. 10.

    Yamashita S, Brudvik KW, Kopetz SE, Maru D, Clarke CN, Passot G, et al. Embryonic origin of primary colon cancer predicts pathologic response and survival in patients undergoing resection for colon cancer liver metastases. Ann Surg. 2018;267(3):514–20.

    Article  Google Scholar 

  11. 11.

    Gasser E, Braunwarth E, Riedmann M, Cardini B, Fadinger N, Presl J, et al. Primary tumour location affects survival after resection of colorectal liver metastases: a two-institutional cohort study with international validation, systematic meta-analysis and a clinical risk score. PLoS ONE. 2019;14(5):e0217411.

    CAS  Article  Google Scholar 

  12. 12.

    Wang Z, Wang X, Zhang Z, Wang X, Chen M, Lu L, et al. Association between primary tumor location and prognostic survival in synchronous colorectal liver metastases after surgical treatment: a retrospective analysis of SEER data. J Cancer. 2019;10(7):1593–600.

    Article  Google Scholar 

  13. 13.

    Moritani K, Hasegawa H, Okabayashi K, Ishii Y, Endo T, Kitagawa Y. Difference in the recurrence rate between right- and left-sided colon cancer: a 17-year experience at a single institution. Surg Today. 2014;44(9):1685–91.

    Article  Google Scholar 

  14. 14.

  15. 15.

  16. 16.

  17. 17.

    Nordlinger B, Sorbye H, Glimelius B, Poston GJ, Schlag PM, Rougier P, et al. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet (London, England). 2008;371(9617):1007–166.

    CAS  Article  Google Scholar 

  18. 18.

    Yagi K, Takahashi H, Akagi K, Matsusaka K, Seto Y, Aburatani H, et al. Intermediate methylation epigenotype and its correlation to KRAS mutation in conventional colorectal adenoma. Am J Pathol. 2012;180(2):616–25.

    CAS  Article  Google Scholar 

  19. 19.

    Yagi K, Akagi K, Hayashi H, Nagae G, Tsuji S, Isagawa T, et al. Three DNA methylation epigenotypes in human colorectal cancer. Clin Cancer Res. 2010;16(1):21–33.

    CAS  Article  Google Scholar 

  20. 20.

    Sakai E, Fukuyo M, Ohata K, Matsusaka K, Doi N, Mano Y, et al. Genetic and epigenetic aberrations occurring in colorectal tumors associated with serrated pathway. Int J Cancer. 2016;138(7):1634–44.

    CAS  Article  Google Scholar 

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We thank JAM Post Inc. (Renton, WA, USA) for proofreading our draft.

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Correspondence to Akira Ouchi.

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Uchino, T., Ouchi, A., Komori, K. et al. The prognostic relevance of primary tumor sidedness to surgical treatment for recurrent colon cancer. Surg Today (2020).

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  • Sidedness
  • Recurrence
  • Colon cancer