SSAT - RECURRENCE AND LONG-TERM SURVIVAL FOLLOWING SEGMENTAL COLECTOMY FOR LEFT-SIDED COLON CANCER IN 450 PATIENTS: A SINGLE-INSTITUTION STUDY

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RECURRENCE AND LONG-TERM SURVIVAL FOLLOWING SEGMENTAL COLECTOMY FOR LEFT-SIDED COLON CANCER IN 450 PATIENTS: A SINGLE-INSTITUTION STUDY
Sara B. Moncrief^*, Eric Dozois, Kevin Wise, Dorin Colibaseanu, Amit Merchea, Kellie L. Mathis
Colon and Rectal Surgery, Mayo Clinic, Rochester, MN

Background: We aimed to study the long-term survival outcomes and patterns of recurrence following segmental colectomy for non-metastatic descending colon and sigmoid colon cancer.
Methods: We identified all consecutive patients who underwent a left or sigmoid colectomy for colon adenocarcinoma at a single institution from January 2000 to December 2007 and then followed them through October 2016. Data collected included demographics, tumor and pathology characteristics, operative and adjuvant therapies, and recurrence and survival outcomes.
Results: We identified 450 patients, 58% male. Median age was 69 years (range, 29 to 93). 347 patients (77%) underwent sigmoid colectomy and 103 (23%) underwent left hemicolectomy. Tumors were located in the sigmoid 81%, descending 17%, and distal transverse colon 2%. Grade of tumor was 1 (<1 %), 2 (32%), 3 (64%), 4 (3%). Median tumor size was 3.5cm (0.3-16.5). Median number of lymph nodes retrieved was 13 (1-66). TNM stage was I (35%), II (33%), and III (31%). Adjuvant chemotherapy was administered in 128 patients (28 patients with stage II disease (19%) and 98 patients with stage III (70%)). Any recurrence occurred in 52 patients (12%), at a median time of 1.7 years (4 months - 16.4 years). First recurrence was local/anastomotic in 11 patients (2%), regional in 3 patients (3%), and distant in 49 patients (11%). At a median follow up of 8.3 years, 267 patients were alive without disease, 3 patients were alive with disease, and 180 patients have died. The 1, 3, 5 and 10 year cancer-specific survival was 98.8%, 92.6%, 87.8%, 73.1%, respectively (Figure 1). The 1, 3, 5, and 10 year overall survival was 94.3%, 87.5%, 80.3%, and 58.4%, respectively. The 1, 3, 5 and 10 year disease-free survival was 91.3%, 82%, 74.5%, and 56.1%, respectively. Univariate predictors of recurrence were tumor size and TNM stage; TNM stage remained significant in the multivariable model. Univariate predictors of overall survival included age, BMI, tumor location (sigmoid > descending > transverse), grade, tumor size, TNM stage, and use of adjuvant chemotherapy; age, tumor grade, and use of adjuvant chemotherapy remained significant in a multivariate analysis.
Conclusions: We report excellent long term cancer outcomes from a large cohort of patients with non-metastatic left sided colon adenocarcinoma treated by segmental colectomy. The majority of failures were due to distant disease highlighting the importance of adjuvant chemotherapy in appropriate patients.

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