Clinical and pathological comparison of proximal and distal colorectal adenocarcinoma
Keywords:Colorectal neoplasms, surgery, human
AIM: Colorectal cancer is a major cause of morbidity and mortality worldwide. Recent studies suggest that proximal and distal colorectal cancers may represent different forms of the disease. The purpose of this study was to evaluate demographic, clinical and pathologic characteristics of colorectal cancer regarding the distribution within the colon and rectum.
METHODS: One hundred fifty-five consecutive patients with primary colorectal carcinoma were analyzed. Proximal (up to the splenic flexure) and distal (splenic flexure to the rectum) colorectal cancers were compared regarding age, gender, stage, differentiation, mucinous content and the presence of distant metastases and peritoneal carcinosis.
RESULTS: No significant difference in age and gender was observed between proximal and distal tumors. Proximal tumors were not significantly more advanced at the time of diagnosis compared to distal tumors according to tumor size, Dukes and Astler-Coller classification. However, proximal tumors had significantly higher frequency of pT4 stage, liver metastases, peritoneal carcinosis and poor differentiation. Mucinous carcinomas were found more often in the proximal colon, but not significantly.
CONCLUSION: These results support the hypothesis that proximal and distal colorectal cancers may have different biological behavior. Further large studies should be performed to evaluate the clinical significance of differences found in this study, and possible impact on screening, diagnosis, therapy and survival.
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