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Comparison of short-term surgical outcomes and long-term survival between emergency and elective surgery for colorectal cancer: a systematic review and meta-analysis

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Abstract

Objective

The objective of this study was to summarize relevant data from previous reports and perform a meta-analysis to compare short-term surgical outcomes and long-term oncological outcomes between emergency and elective surgery for colorectal cancer (CRC).

Methods

A systematic literature search was performed using PubMed and Embase databases, and relevant data were extracted. Postoperative morbidity, hospital mortality within 30 days, postoperative recovery, overall survival (OS), and relapse-free survival (RFS) were compared using a fixed or random-effect model.

Results

A total of 28 studies involving 353,686 participants were enrolled for this systematic review and meta-analysis, and 23.5% (83,054/353,686) of CRC patients underwent emergency surgery. The incidence of emergency presentations in CRC patients ranged from 2.7 to 38.8%. The lymph node yield of emergency surgery was comparable to that of elective surgery (WMD:0.70, 95%CI: − 0.74,2.14, P = 0.340; I2 = 80.6%). Emergency surgery had a higher risk of postoperative complications (OR:1.83, 95%CI:1.62–2.07, P < 0.001; I2 = 10.6%) and hospital mortality within 30 days (OR:4.62, 95%CI:4.18–5.10, P < 0.001; I2 = 42.9%) than elective surgery for CRC. In terms of long-term oncological outcomes, emergency surgery was significantly associated with poorer RFS (HR: 1.51, 95%CI:1.24–1.83, P < 0.001; I2 = 58.9%) and OS(HR:1.60, 95%CI: 1.47–1.73, P < 0.001; I2 = 63.4%) of CRC patients. In addition, the subgroup analysis for colon cancer patients revealed a pooled HR of 1.73 for OS (95%CI:1.52–1.96, P < 0.001), without the evidence of significant heterogeneity (I2 = 21.2%).

Conclusion

Emergency surgery for CRC had an adverse impact on short-term surgical outcomes and long-term survival. A focus on early screening programs and health education was warranted to reduce emergency presentations of CRC patients.

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Data availability

All data are available from its supplementary files.

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Funding

This work was supported by the General Scientific Research Project of Education Department of Zhejiang Province (Y201636252, Y202146966), the Zhejiang Provincial Key Project of Research and Development (2019C03043), the Health Science and Technology Plan of Zhejiang Province (2022RC165), and the Clinical Research Fund of the Zhejiang Medical Association (2021ZYC-A68).

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Authors and Affiliations

  1. Nursing Department, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, Hangzhou, 310000, China

    Haiyan Zhou & Yongyan **

  2. Department of Gastroenterology Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, China

    Jun Wang, Guofeng Chen & Jian Chen

  3. Department of Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, Hangzhou, 310000, China

    Shaojun Yu

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Contributions

Haiyan Zhou conducted data analysis and drafted the original manuscript; Yongyan ** and Jun Wang contributed to data interpretation and statistical analysis; Guofeng Chen contributed to manuscript editing and preparation; Jian Chen and Shaojun Yu conceptualized study design and critically reviewed this manuscript. All authors read and approved the final edition.

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Zhou, H., **, Y., Wang, J. et al. Comparison of short-term surgical outcomes and long-term survival between emergency and elective surgery for colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 38, 41 (2023). https://doi.org/10.1007/s00384-023-04334-8

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