Evaluating quality of colorectal cancer surgery across elective and emergency health systems: secondary…

Cohort studyBJS open· Jul 2026

Evaluating quality of colorectal cancer surgery across elective and emergency health systems: secondary analysis of prospective cohort studies in 95 countries.

Sivesh K Kamarajah, Adewale O Adisa, Ajay Aggarwal … NIHR Global Health Research Unit on Global Surgery

OncologyCohort studyClinical practiceQ1IF 3.6

Emergency colorectal cancer surgery is associated with higher odds of margin-positive resections.

Evaluating quality of colorectal cancer surgery across elective and emergency health systems: secondary analysis of prospective cohort studies in 95 countries.

Sivesh K Kamarajah … NIHR Global Health Research Unit on Global Surgery

BJS open · Jul 2026 · Q1 in General Medicine

Background

The Lancet Oncology Commission on Global Cancer Surgery recommended that access to and the quality of surgical care be improved.

Purpose

This study aimed to understand differences in surgical quality between emergency and elective resection among patients with potentially curative colorectal cancer.

Methods

This preplanned secondary analysis included patients undergoing only curative-intent surgery for colorectal cancer from three contemporary global prospective cohort studies (GlobalSurg-3, 5506 patients; CovidSurg-Cancer, 6719 patients; APOLLO, 876 patients) registered from 2018 to 2023.

n = 6719 patients

Results

emergency surgery means over twice the risk of cancer cells left behind

OR 2.45 (95% CI 1.86 to 3.22)

null 1

1.86

3.22

CI excludes the null - significant

More results

Overall, 678 patients (5.4%) had margin-positive resections, with higher rates in the emergency than elective surgery group (13.7 versus 4.5%; P < 0.0001).

Bootstrap-derived absolute risk differences revealed the greatest disparities in patients with stage III-IV rectal cancers, with absolute differences of 12.6% (95% c.i.

More results

Variance decomposition demonstrated that hospital- and country-level factors accounted for 76% of the explained variation in surgical quality.

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Conclusion · 1 of 2

Emergency surgery was associated with a two- to threefold increase in the risk of margin-positive resections globally, independent of resource availability, highlighting a neglected area of global surgical practice.

Conclusion · 2 of 2

These findings challenge the assumption that poorer outcomes after emergency surgery are due to advanced disease stage.

Evaluating quality of colorectal cancer surgery across elective and emergency health systems: secondary analysis of prospective cohort studies in 95 countries.

Evaluating quality of colorectal cancer surgery across elective and emergency health systems: secondary analysis of prospective cohort studies in 95 countries.

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