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Session: ePoster: Colon and Colorectal Cancer 18 (Tue8)

EP930 - Global variations in the provision of emergency colorectal cancer care: an international prospective cohort study

Tuesday, May 13, 2025
8:38 AM – 8:43 AM PT

    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.

    • Senior Author(s)

  • 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.

    • ePoster Presenter(s)

  • Kara R. Proctor (she/her/hers)

    Medical Student Class of 2026
    University of Illinois College of Medicine Peoria
    Peoria, IL, United States

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
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.
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: 920 patients presented acutely with colon cancer deemed for curative management (225 centres, 36 countries; median age 69 years; 55% female; median clinical frailty score 3.0, 57% left-sided, 43% right-sided), of which 821 underwent surgery. Overall 534 (65%) patients had open surgery, 263 (32%) had laparoscopic surgery, and 24 (2.9%) had robotic surgery. Rates of MIS surgery varied by centre (Figure 1) and were 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 a significantly higher mortality (OR 3.06, 95% CI 1.31 - 7.13, p = 0.09), reduced days alive and out of 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 index acute 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 hospital in this global prospective cohort study.