TY - JOUR
T1 - Outcomes After Elective Versus Emergency Resection for Right-Sided Colon Cancer
T2 - A Propensity-Score Matched Analysis
AU - Kertzman, Bas A.J.
AU - Amelung, Femke J.
AU - Burghgraef, Thijs A.
AU - Consten, Esther C.J.
AU - Draaisma, Werner A.
N1 - Publisher Copyright:
© The ASCRS 2025.
PY - 2025/6
Y1 - 2025/6
N2 - BACKGROUND: Previous studies reported similar complication rates, including anastomotic leakage, after elective and emergency surgery for right-sided colon cancer. This led to the consensus that emergency resection with primary anastomosis is safe. However, recent evidence suggests higher complication rates after emergency surgery, indicating that alternative strategies, such as a bridge to surgery, may be more suitable. OBJECTIVE: To assess whether complication rates, particularly anastomotic leakage, are higher after emergency resections compared to elective resections in patients with right-sided colon cancer. DESIGN: A retrospective cohort study using data from the Dutch ColoRectal Audit from 2010 to 2019. SETTINGS: Nationwide data from hospitals across the Netherlands. PATIENTS: Patients who underwent resection for right-sided colon cancer (n = 5056 emergency resections matched 1:1 to elective resections using propensity score matching). MAIN OUTCOME MEASURES: Incidence of anastomotic leakage, 90-day complication rates, and mortality rates after elective versus emergency surgery for right-sided colon cancer. RESULTS: After matching, no significant baseline differences remained. There was no significant difference in anastomotic leakage rates. However, the mortality rate was twice as high in the emergency group (9.4% vs 4.2%, p < 0.001), and the 90-day complication rate was also higher (41.7% vs 33.0%, p < 0.001). LIMITATIONS: Minimal missing data were handled with multiple imputation. Although propensity score matching was used, bias from unknown confounders may persist. The emergency group included more high-risk patients, potentially influencing outcomes. CONCLUSIONS: Emergency resections for right-sided colon cancer are associated with higher complication and mortality rates compared to elective surgery. A bridge-to-surgery approach could reduce these risks by converting emergency cases to elective procedures. Further research is needed to validate these findings.
AB - BACKGROUND: Previous studies reported similar complication rates, including anastomotic leakage, after elective and emergency surgery for right-sided colon cancer. This led to the consensus that emergency resection with primary anastomosis is safe. However, recent evidence suggests higher complication rates after emergency surgery, indicating that alternative strategies, such as a bridge to surgery, may be more suitable. OBJECTIVE: To assess whether complication rates, particularly anastomotic leakage, are higher after emergency resections compared to elective resections in patients with right-sided colon cancer. DESIGN: A retrospective cohort study using data from the Dutch ColoRectal Audit from 2010 to 2019. SETTINGS: Nationwide data from hospitals across the Netherlands. PATIENTS: Patients who underwent resection for right-sided colon cancer (n = 5056 emergency resections matched 1:1 to elective resections using propensity score matching). MAIN OUTCOME MEASURES: Incidence of anastomotic leakage, 90-day complication rates, and mortality rates after elective versus emergency surgery for right-sided colon cancer. RESULTS: After matching, no significant baseline differences remained. There was no significant difference in anastomotic leakage rates. However, the mortality rate was twice as high in the emergency group (9.4% vs 4.2%, p < 0.001), and the 90-day complication rate was also higher (41.7% vs 33.0%, p < 0.001). LIMITATIONS: Minimal missing data were handled with multiple imputation. Although propensity score matching was used, bias from unknown confounders may persist. The emergency group included more high-risk patients, potentially influencing outcomes. CONCLUSIONS: Emergency resections for right-sided colon cancer are associated with higher complication and mortality rates compared to elective surgery. A bridge-to-surgery approach could reduce these risks by converting emergency cases to elective procedures. Further research is needed to validate these findings.
KW - Bridge to surgery
KW - Elective resection
KW - Emergency surgery
KW - Propensity score matching
KW - Right-sided colon cancer
KW - Short term outcomes.
UR - https://www.scopus.com/pages/publications/105002620435
U2 - 10.1097/DCR.0000000000003680
DO - 10.1097/DCR.0000000000003680
M3 - Article
AN - SCOPUS:105002620435
SN - 0012-3706
VL - 68
SP - 753
EP - 763
JO - Diseases of the Colon and Rectum
JF - Diseases of the Colon and Rectum
IS - 6
ER -