Does the outcome of colonic flexure cancers differ from the other colonic sites?

Anecdotally, colonic flexure cancers (FC) appear to have a poorer prognosis compared to other colonic cancers (OCC). The aim of this study was to determine the outcome of colonic flexure cancers compared to the cancers of the rest of the colon.

Patients with a diagnosis of colonic cancer over a 5-year period (2002-2006) were retrieved from a prospective database. Analysis was performed on flexure (hepatic/splenic) cancers versus remaining colon cancers. Overall, 1-, 3- and 5-year survival rates were calculated. All patients were followed up until death or end of study period (December 2008), with median follow-up of 32 months. Statistical analysis was performed using Kaplan-Meier with log rank statistic and Pearson chi-square test.

Of 613 patients (54% males) with colonic cancers with median age 71 years, range (30-100), 67 (10.9%) were FC (35 hepatic/32 splenic) and 546 (89.1%) were arising from OCC. The curative resection rates were FC 73.2% (41 of 56) and OCC 83.4% (359 of 435) (p = 0.05). Post-operative mortality for FC and OCC was 10.7% (6 of 56) and 4.2% (18 of 434), respectively (p = 0.04). FC presented at a more advanced Dukes stage (p = 0.003). Recurrence rates were 9.8% (4 of 41) for FC and 20.9% (75 of 359) for OCC sites (p = 0.088). The overall mean survival was 48.8 and 58.2 m for FC and OCC, respectively (p = 0.158). Of 1-, 3- and 5-year survival, only 1-year survival was significantly different between the two groups (OCC (85%) vs FC (75%), p = 0.018).

Nearly one in ten colonic cancers is located at a flexure. Despite FC presenting at an advanced stage, leading to a lower curative resection rate, no significant survival difference was noted compared to other colonic sites, beyond the first year.