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Session: ePoster: Colon and Colorectal Cancer 4 (Sun1230)

EP438 - Outcomes of Minimally-invasive Versus Open Colon Cancer Surgery in Acutely Presenting Colon Cancer Managed With Curative Intent: Results from APOLLO-Study

Sunday, May 11, 2025
1:08 PM – 1:13 PM PT
Location: Monitor 5, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Muhammed Elhadi, MBBCh (he/him/his)

    Medical Doctor and Researcher in Training
    Department of Surgery, Houston Methodist Hospital
    Tripoli, TX, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Chris Varghese, MBChB, BMedSc(Hons)

    Junior Doctor and PhD Candidate
    University of Auckland
    Auckland, Auckland, New Zealand

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no relevant relationships with ineligible companies.

  • WX

    William Xu, MBChB, BMedSc(Hons)

    Resident
    University of Auckland
    Auckland, Auckland, New Zealand

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • EC

    EuroSurg Collaborative, MBChB

    Student- and Trainee Research Collaborative
    EuroSurg Collaborative
    Auckland, Auckland, New Zealand

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Muhammed Elhadi, MBBCh: This individual has no financial relationships with ineligible companies.
Chris Varghese, MBChB, BMedSc(Hons): This individual has no relevant relationships with ineligible companies.
William Xu, MBChB, BMedSc(Hons): This individual has no financial relationships with ineligible companies.
EuroSurg Collaborative, MBChB: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Minimally invasive colon cancer surgery is thought to provide reduced morbidity and mortality in the acute setting, however literature to date has been predominantly retrospective or focused on the elective setting. Here we investigate global outcomes comparing minimally invasive (MIS) and open colon cancer surgery in the acute setting.

Methods/Interventions: Acute PresentatiOn of coLorectaL cancer - an internatiOnal snapshot (APOLLO) was a prospective cohort study which enrolled consecutive adults presenting acutely with colorectal cancer between January and June 2023. In this planned secondary analysis, mixed-effects regression models were constructed to derive risk-adjusted models for the primary outcome of 90-day mortality and the secondary outcomes of 90-day unplanned readmission and days alive and out of hospital at 90 days (DAOH-90).

Results/Outcomes: In this cohort, 920 patients with acutely presented colon cancer were deemed candidates for curative management across 225 centers in 36 countries (median age 69 years; 55% female; median clinical frailty score of 3.0; 57% with left-sided tumors and 43% with right-sided tumors). Among them, 821 underwent surgery. Overall, 534 patients (65%) had open surgery, 263 (32%) had laparoscopic surgery, and 24 (2.9%) had robotic surgery. The rates of minimally invasive surgery (MIS) varied by center, being higher in high-income countries (40%) compared to low- and middle-income countries (23%; p< 0.001). After risk adjustment, open surgery was associated with significantly higher mortality (OR 3.06, 95% CI 1.31 - 7.13, p = 0.09), fewer days alive and out of the hospital (adjusted mean 56 days vs. 61 days, p = 0.03), and similar rates of unplanned readmissions (OR 1.25, 95% CI 0.67 - 2.35, p = 0.5) within 90 days of the initial hospital presentation.

Conclusion/Discussion: Minimally invasive surgery remains the optimal approach for curative intent colon cancer resections in the acute setting, as evidenced by improved mortality and days alive and out of the hospital in this global prospective cohort study.