Clinicopathological features and prognosis of synchronous and metachronous colorectal cancer: a retrospective cohort study

To investigate the clinicopathological features and prognosis of synchronous and metachronous multiple primary colorectal cancer.Patients who underwent operation for synchronous and metachronous colorectal cancer at the colorectal surgery department of XX Hospital between January 2000 and December 2021 were included. Perioperative indicators were comprehensively compared and included in the survival analyses.In total, 563 patients with synchronous (n=372) and metachronous (n=191) colorectal cancer were included. Patients with synchronous colorectal cancer were more likely to have a long onset time, positive carcinoembryonic antigen, advanced TNM stage, large tumor, perineural invasion, p53 high expression, and mismatch repair proficient. Compared with metachronous colorectal cancer, patients with synchronous colorectal cancer showed worse 5-year overall survival (68.6%±3.0% vs 81.9%±3.5%, P=0.018) and 5-year disease-free survival (61.2%±3.1% vs 71.0%±3.9%, P=0.022). In the subgroup analysis, segmental resection was an independent risk factor for the long-term outcomes of bilateral synchronous colorectal cancer.Clinicopathological and molecular features were different between synchronous and metachronous colorectal cancer. Patients with synchronous colorectal cancer showed a worse prognosis than those with metachronous colorectal cancer. Bilateral synchronous colorectal cancer requires extended resection to achieve improved long-term outcomes.