Hepatic flexture1/30/2024 However, as a junctional site between the right and left colon, lymphatic drainage and vascular supply of the transverse colon including flexures lie between the right and left anatomical territories and their anatomopathological features have not been fully elucidated. However, growing evidence has shown that PTR could prolong the survival of patients with unresectable CRLM. For these patients with unresectable CRLM, the guidelines of the National Comprehensive Cancer Network (NCCN) do not recommend PTR unless there is obstruction, acute bleeding, or perforation. However, at the time of diagnosis, 75–90% of CRC patients are unable to undergo surgical resection because of liver metastasis. At the same time, higher morbidity and mortality associated with complete surgical resection is one of the main reasons to limit its application, so many surgeons recommend the traditional staged approach that includes PTR, followed by systemic chemotherapy then resection of liver metastases for patients without progression of the disease. ![]() However, patients with smaller or fewer liver metastases and right-sided CRC selected for complete surgical resection are easier to approach operatively. The ideal surgical treatment for patients with colorectal cancer liver metastasis (CRLM) seems to be complete surgical resection of liver metastases at the time of primary tumor resection (PTR). Among them, the liver is the most common metastatic site, and liver metastasis is an important cause of death in patients with CRC. Unfortunately, about 30–40% of CRC patients are diagnosed with metastatic CRC, and another 30% will develop metastatic CRC later. The morbidity of CRC has increased continuously in recent years, with more than 1.8 million confirmed cases reported in 2018. For oncologic outcomes, we concluded that segmental colon resection seemed an effective surgical procedure for UTCLM, UHFLM, and USFLM.Ĭolorectal cancer (CRC) is one of the most common cancers with the second-highest morbidity in men and women and the second leading cause of cancer-related death worldwide. Besides, PTR may not improve the prognosis of USFLM patients with CEA- negative or tumor size≤5 cm. ![]() We confirmed the different survival of patients with UTCLM, UHFLM, and USFLM, and for the first time, we proved that PTR could provide survival benefits for patients with unresectable CRLM from the perspective of colonic subsites of transverse colon, hepatic flexure, and splenic flexure. There was no difference between segmental colon resection and larger colon resection on CSS of UHFLM, UTCLM, and USFLM patients. Multivariate analysis showed that PTR and perioperative chemotherapy were common independent prognostic factors for UHFLM, UTCLM, and USFLM patients. Subgroups analysis revealed that USFLM patients with tumor size≤5 cm and negative CEA had not demonstrated an improved OS and CSS after PTR. PTR could improve the OS and CSS of UTCLM, UHFLM, and USFLM (All P < 0.001). UHFLM patients had the worst OS and CSS (All P < 0.001). USFLM patients had the best OS and CSS, followed by UTCLM patients. The median survival time of whole patients was 11.0 months, ranging from 7.0 months for UHFLM patients to 15.0 months for USFLM patients. In total, this study included a cohort of 1960 patients: 556 cases of UHFLM, 1008 cases of UTCLM, and 396 cases of USFLM. ![]() Kaplan-Meier analyses and log-rank tests were conducted to assess the effectiveness of PTR on survival. Cox proportional hazards regression models were used to identify prognostic factors of overall survival (OS) and cause-specific survival (CSS). ![]() The patients were identified from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. We aimed to evaluate the effect of primary tumor resection (PTR) and different scope of colectomy on the prognosis of patients with unresectable transverse colon cancer liver metastasis (UTCLM), hepatic flexure cancer liver metastasis (UHFLM), and splenic flexure cancer liver metastasis (USFLM). Studies on unresectable colorectal cancer liver metastasis(CRLM) rarely analyze the prognosis of the patients from the point of colonic subsites.
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