Nursing Department, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, Hangzhou, 310000, China.
Department of Gastroenterology Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, China.
Int J Colorectal Dis. 2023 Feb 15;38(1):41. doi: 10.1007/s00384-023-04334-8.
The objective of this study was to summarize relevant data from previous reports and perform a meta-analysis to compare short-term surgical outcomes and long-term oncological outcomes between emergency and elective surgery for colorectal cancer (CRC).
A systematic literature search was performed using PubMed and Embase databases, and relevant data were extracted. Postoperative morbidity, hospital mortality within 30 days, postoperative recovery, overall survival (OS), and relapse-free survival (RFS) were compared using a fixed or random-effect model.
A total of 28 studies involving 353,686 participants were enrolled for this systematic review and meta-analysis, and 23.5% (83,054/353,686) of CRC patients underwent emergency surgery. The incidence of emergency presentations in CRC patients ranged from 2.7 to 38.8%. The lymph node yield of emergency surgery was comparable to that of elective surgery (WMD:0.70, 95%CI: - 0.74,2.14, P = 0.340; I = 80.6%). Emergency surgery had a higher risk of postoperative complications (OR:1.83, 95%CI:1.62-2.07, P < 0.001; I = 10.6%) and hospital mortality within 30 days (OR:4.62, 95%CI:4.18-5.10, P < 0.001; I = 42.9%) than elective surgery for CRC. In terms of long-term oncological outcomes, emergency surgery was significantly associated with poorer RFS (HR: 1.51, 95%CI:1.24-1.83, P < 0.001; I = 58.9%) and OS(HR:1.60, 95%CI: 1.47-1.73, P < 0.001; I = 63.4%) of CRC patients. In addition, the subgroup analysis for colon cancer patients revealed a pooled HR of 1.73 for OS (95%CI:1.52-1.96, P < 0.001), without the evidence of significant heterogeneity (I = 21.2%).
Emergency surgery for CRC had an adverse impact on short-term surgical outcomes and long-term survival. A focus on early screening programs and health education was warranted to reduce emergency presentations of CRC patients.
本研究旨在总结以往研究报告中的相关数据，并进行荟萃分析，比较结直肠癌（CRC）急诊手术与择期手术的短期手术结果和长期肿瘤学结果。
使用 PubMed 和 Embase 数据库进行系统文献检索，并提取相关数据。使用固定或随机效应模型比较术后发病率、30 天内院内死亡率、术后恢复、总生存率（OS）和无复发生存率（RFS）。
本系统评价和荟萃分析共纳入 28 项研究，涉及 353686 名参与者，其中 23.5%（83054/353686）的 CRC 患者接受了急诊手术。CRC 患者的急诊就诊率为 2.7%至 38.8%。急诊手术的淋巴结检出量与择期手术相当（WMD：0.70，95%CI：-0.74，2.14，P=0.340；I=80.6%）。急诊手术术后并发症风险较高（OR：1.83，95%CI：1.62-2.07，P<0.001；I=10.6%）和 30 天内院内死亡率（OR：4.62，95%CI：4.18-5.10，P<0.001；I=42.9%）均高于择期手术。在长期肿瘤学结果方面，急诊手术与 CRC 患者的 RFS（HR：1.51，95%CI：1.24-1.83，P<0.001；I=58.9%）和 OS（HR：1.60，95%CI：1.47-1.73，P<0.001；I=63.4%）显著相关。此外，对结肠癌患者的亚组分析显示 OS 的合并 HR 为 1.73（95%CI：1.52-1.96，P<0.001），且无明显异质性（I=21.2%）。
CRC 的急诊手术对短期手术结果和长期生存有不利影响。需要关注早期筛查计划和健康教育，以减少 CRC 患者的急诊就诊。
