Outcomes After Elective Versus Emergency Resection for Right-Sided Colon Cancer: A Propensity Score-Matched Analysis

Area of Science:

• Colorectal surgery
• Surgical oncology
• Gastrointestinal oncology

Background:

• Previous studies suggested similar complication rates for elective and emergency right-sided colon cancer resections.
• This led to a consensus favoring emergency resection with primary anastomosis.
• However, recent evidence indicates higher complication rates in emergency settings, prompting re-evaluation.

Purpose of the Study:

• To compare complication and anastomotic leakage rates between emergency and elective resections for right-sided colon cancer.
• To assess the impact of surgical timing on patient outcomes.

Main Methods:

• Retrospective cohort study utilizing nationwide data from the Dutch ColoRectal Audit (2010-2019).
• Propensity score matching (1:1) was employed to compare 5056 emergency resections with elective resections.
• Outcomes assessed included anastomotic leakage, 90-day complications, and mortality.

Main Results:

• No significant difference in anastomotic leakage rates was observed between emergency and elective groups.
• Mortality rates were significantly higher in the emergency group (9.4% vs. 4.2%, p < 0.001).
• Ninety-day complication rates were also higher for emergency resections (41.7% vs. 33.0%, p < 0.001).

Conclusions:

• Emergency resection for right-sided colon cancer is associated with increased mortality and complication risks compared to elective surgery.
• A "bridge-to-surgery" strategy may mitigate these risks by enabling elective procedures.
• Further research is warranted to confirm these findings and optimize treatment strategies.