Differential survival outcomes and prognostic factors across surgical approaches for colorectal cancer: Analysis of 5000 patients from the SEER database

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Background Colorectal cancer (CRC) management involves several surgical approaches, but the differential impact of these procedures on patient outcomes remains incompletely understood. This study analyzed 5,000 CRC patients from the SEER database to evaluate survival differences and prognostic factors among three surgical approaches: left hemicolectomy, rectal resection, and right hemicolectomy. Methods We conducted a retrospective analysis of 5,000 CRC patients (1,738 left hemicolectomy, 1,622 rectal resection, and 1,640 right hemicolectomy). Patient characteristics, pathological features, treatment patterns, and survival outcomes were compared across surgical approaches. Univariate and multivariate analyses were performed to identify prognostic factors. Results Significant demographic and clinicopathological differences were observed across surgical groups. Right hemicolectomy yielded the highest lymph node harvest (24.20±9.96, p=0.009) and demonstrated superior survival outcomes compared to left hemicolectomy and rectal resection (HR=2.17, 95% CI: 1.77-2.67, p<0.001). Age ≥55 years (HR=1.93, p=0.005), male gender (HR=1.03, p=0.04), and lymph node positivity (HR=1.99, p=0.04) were significant negative prognostic factors. Adequate lymph node harvesting (≥12 nodes) was associated with improved survival, particularly in node-positive patients (HR=1.19, p=0.018) and those undergoing rectal resection (HR=1.20, p=0.047). Conclusion This SEER-based analysis reveals that right hemicolectomy is associated with better survival outcomes in colorectal cancer compared to other surgical approaches.