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

Abstract

Background: The objective of this study was to summarize data from previous relevant reports and perform a meta-analysis to compare short-term surgical outcomes and long-term oncological outcomes between emergency resection and elective resection for colorectal cancer(CRC). Methods: A systematic literature search was performed using PubMed and Embase databases and relevant data were extracted. Postoperative morbidity and mortality within 30 days, postoperative recovery, overall survival(OS) and relapse-free survival(RFS) of the two surgical nature were compared using a fixed or random-effect model. Results: In total, we identified 28 relevant studies involving 353,686 participants for this systematic review and meta-analysis, and 23.5%(83,054/353,686) of CRC patients underwent emergency surgery. Based on the included reports, the incidence of emergency presentations in CRC patients ranged from 2.7% to 38.8%. 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 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 significantly associated with recurrence(HR for RFS: 1.51, 95%CI:1.24-1.83, P<0.001; I2=58.9%) and poorer OS(HR:1.60, 95%CI: 1.47-1.73, P<0.001; I2=63.4%) in CRC patients. 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 evidence of significant heterogeneity(I2=21.2%). Conclusion: Emergency resection for CRC had an adverse impact on short-term surgical outcomes and long-term survival. A focus on early screening programs and health education were warranted to reduce emergency presentations of CRC patients.