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Objective: Colon (CC) and rectal cancer (RC) differ in etiology, metastatic patterns and treatment response. However, both cancers are often analyzed together. The aim of this study is to assess the differences between early stage CC and RC, looking at both short- and long-term outcomes.
Design: Retrospective analyses.
Setting: Tertiary care center.
Patients: All non-neoadjuvantly treated pathological AJCC stage I colon and rectal cancer patients who underwent surgery between 2004-2014.
Main Outcome Measures: Clinicopathological differences and long-term oncological outcomes.
Results: A total of 360 CC and 94 RC patients were included. CC patients had a significantly higher Charlson-score, were older (mean 66.8 vs. 62.8, P<0.01), and more often urgently admitted (P<0.05). RC patients had a longer surgery duration (128 vs. 186 minutes, P<0.001), and a higher readmission and 30-morbidity rate (P<0.01). CC patients had more High grade tumors, HLMH1 and HPMS2 loss in immunohistochemical staining, and less R0 resections (94.4% vs. 100%) (P<0.03). Kaplan-Meier curves for recurrent disease, whether local or distant, was significantly different with an estimate five-year disease free-survival (DFS) of 99.4% for CC versus 86.9% for RC patients (P=0.008). Overall survival rates were comparable, although there was a trend toward worse five-year survival for RC (87.7%) versus CC (95.8%) (P=0.618).
Conclusions: This study underlines essential differences between stage I colon and rectal cancer patients, with a higher 30-day morbidity and a shorter five-year disease free survival for RC patients. Research focusing on colorectal cancer should take the differences within these two diseases into account.