Abstract
Colorectal cancer remains a significant cause of morbidity and mortality, even despite curative treatment. A significant proportion of patients present emergently and have poorer outcomes compared to elective presentations, independent of TNM stage. In this systematic review and meta-analysis, differences between elective/emergency presentations of colorectal cancer were examined to determine which factors were associated with emergency presentation. A literature search was carried out from 1990 to 2018 comparing elective and emergency presentations of colon and/or rectal cancer. All reported clinicopathological variables were extracted from identified studies. Variables were analysed through either systematic review or, if appropriate, meta-analysis. This study identified multiple differences between elective and emergency presentations of colorectal cancer. On meta-analysis, emergency presentations were associated with more advanced tumour stage, both overall (OR 2.05) and T/N/M/ subclassification (OR 2.56/1.59/1.75), more: lymphovascular invasion (OR 1.76), vascular invasion (OR 1.92), perineural invasion (OR 1.89), and ASA (OR 1.83). Emergencies were more likely to be of ethnic minority (OR 1.58). There are multiple tumour/host factors that differ between elective and emergency presentations of colorectal cancer. Further work is required to determine which of these factors are independently associated with emergency presentation and subsequently which factors have the most significant effect on outcomes.
Highlights
Colorectal cancer remains a significant cause of morbidity and mortality, even despite curative treatment
The National Bowel Cancer Audit 2 0172 reported that 75% of those patients diagnosed with colorectal cancer in England and Wales undergo curative treatment though, despite this, a significant number of these patients succumb from their disease
The present systematic review and meta-analysis confirms multiple differences in tumour, host and other factors between elective and emergency presentations of colorectal cancer. It may be a combination of these factors that are associated with the poorer short- and long-term outcomes reported in emergency presentations of colorectal cancer[10,11] rather than emergency presentation per se
Summary
Colorectal cancer remains a significant cause of morbidity and mortality, even despite curative treatment. In this systematic review and metaanalysis, differences between elective/emergency presentations of colorectal cancer were examined to determine which factors were associated with emergency presentation. This study identified multiple differences between elective and emergency presentations of colorectal cancer. There are multiple tumour/host factors that differ between elective and emergency presentations of colorectal cancer. While factors including more advanced disease stage and higher American Society of Anaesthesiology (ASA) Grade at presentation may contribute to this, recent research suggests that emergency presentation remains an independent poor prognostic indicator following curative colorectal r esection[10,11]. It is likely that the worse outcomes observed in emergency compared to elective presentations of colorectal cancer are due to disparities in tumour and host factors between modes of presentation rather than being due to emergency presentation per se.
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