Banks, J., Rashid, A., Wilson, T.R. et al. (2 more authors) (2025) Process and outcome differences in the care of patients undergoing elective and emergency right hemicolectomy. The Annals of The Royal College of Surgeons of England, 107 (3). pp. 188-193. ISSN 0035-8843
Abstract
Introduction
Up to 30% of patients with colorectal cancer present as an emergency and have worse outcomes than elective patients. Compared with left-sided cancers, malignancies arising in the right colon are significantly under-researched. We sought to compare cancer care quality and clinical outcomes between emergency and elective presentations of right-sided colon cancer (RCC).
Methods
This multicentre, retrospective study included all patients who underwent operative management for a RCC, from 1 April 2017 to 31 March 2022. Data were collected from electronic patient records, and host and tumour factors as well as outcomes between emergency and elective cohorts were compared.
Results
Overall, 806 patients (median age 72 years) were included. Some 175 patients (22%) presented as an emergency: 140 in obstruction and 35 with tumour perforation, compared with 1 patient with tumour perforation in the elective group (p < 0.001). The emergency group had higher rates of postoperative complications (59.1% vs 20.0%, p < 0.001), increased 90-day mortality (13.7% vs 1.3%, p < 0.001) and a longer hospital stay (5 vs 10 days, p < 0.001). From the emergency cohort only 29.2% of eligible patients received adjuvant chemotherapy and in multivariate regression analysis emergency presentation was associated with a decreased likelihood of receiving adjuvant chemotherapy (odds ratio 0.26 [0.14–0.47], p < 0.001).
Conclusions
Both short- and long-term outcomes after emergency presentation of RCC are poor, with inadequate access to subsequent chemotherapy. Strategies addressing emergency presentations of left-sided tumours have moved towards temporisation and elective surgery. Delaying major resectional surgery for optimisation may improve outcomes and access to adjuvant therapies for RCC.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2024, The Authors. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License, (https://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, reproduction, and adaptation in any medium, provided the original work is properly attributed. |
Keywords: | Colon cancer; Outcomes |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Medicine and Population Health |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 07 Aug 2024 16:14 |
Last Modified: | 07 Mar 2025 15:31 |
Status: | Published |
Publisher: | Royal College of Surgeons of England |
Refereed: | Yes |
Identification Number: | 10.1308/rcsann.2024.0056 |
Related URLs: | |
Sustainable Development Goals: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:215800 |