Process and outcome differences in the care of patients undergoing elective and emergency right hemicolectomy.

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.