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Survival Following Colorectal Cancer Surgery in Low- and Middle-Income Countries: A Systematic Review and
Oluwasegun Afolaranmi1, Thomas M Diehl2, Sehar Salim Virani2,3
1Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Background And Objectives:
Surgery is the mainstay of treatment for localized colorectal cancer (CRC); however, little is known about survival outcomes following CRC surgery in low- and middle-income countries (LMICs). Here, we examine the available data on long-term outcomes following CRC resections in LMICs.
Methods:
A systematic review and meta-analysis were conducted on primary research studies reporting survival data after CRC resection with curative intent in LMICs. Disease-free survival (DFS) and overall survival (OS) data were extracted, and random effects modelling was used to estimate the pooled survival rates.
Results:
One hundred and fifty-four studies representing 20,589 CRC patients were analyzed. Notably, only 27 (20%) of the 137 LMICs were represented in the literature. The pooled 5-year OS estimate was 88% (95% CI: 77-95), 76% (69-81), and 57% (49-64) for Stages I, II, and III, respectively. 5-year DFS estimates were 82% (71-90), 76% (67-84), and 59% (51-65) for stages I, II, and III, respectively. Combined OS and DFS estimates for all three stages were 76% and 69%, respectively. Survival rates varied considerably across the included studies and between income groups.
Conclusions:
With the rising incidence of CRC globally, our work highlights the dearth of data on long-term outcomes following CRC operations in most LMICs and emphasizes the urgent need for research capacity building.
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