Outcomes Following Elective Versus Emergency Resection for Right-Sided Colon Cancer: A Propensity-Score Matched Analysis

BACKGROUND: Previous studies reported similar complication rates, including anastomotic leakage, following 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, like a bridge to surgery, may be more suitable. OBJECTIVE: To assess whether complication rates, particularly anastomotic leakage, are higher following emergency resections compared to elective resections in patients with right-sided colon cancer. DESIGN: A retrospective cohort study utilizing 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 following 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. While 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. See Video Abstract .