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I read with interest the paper by Yamauchi et al,1 which disputes the prevailing (to date) ‘two-colon’ concept suggesting that proximal and distal colorectal cancer (CRC) may represent two distinct disease entities (with the splenic flexure as a discrete point).2 The emerging new approach supports a gradual rather than an abrupt change of tumour molecular features throughout the colorectum and also the existence of certain disparities among particular colonic subsites (‘continuum/multisegmental’ concept).1
However, the two concepts are not necessarily conflicting. First, the existing differences between proximal and distal normal colon in embryologic origin, blood supply, innervation, bile acids metabolism, fermentation reactions and function are indisputable. Similarly acceptable are the long-ago known disparities between proximal and distal tumours in macroscopic appearance and clinical manifestation.1 , …
Competing interests None.
Provenance and peer review Not commissioned; internally peer reviewed.