Socioeconomic Impact of Emergency Therapies for Colorectal Cancer

  • Aleix Martínez-Pérez
  • Carmen Payá-Llorente
  • Arturo García-Lozano
Part of the Hot Topics in Acute Care Surgery and Trauma book series (HTACST)


Colorectal cancers are the third most common malignant tumors worldwide and are associated with an increased economic expenditure for healthcare systems due to its high diagnostic, therapeutic, and follow-up costs. Elective surgical resection is the gold standard for CRCs curative treatment, but up to 30% of CRC patients are presenting at emergency setting. Emergency surgery for CRC increases postoperative morbidity, mortality, length of admissions, and costs. Moreover, curative resection rates are lower and recurrences higher after emergency operations. There is substantial heterogeneity in the methodologies and quality of the published economic evaluations of CRC, and emergency surgery may represent an underestimated cost burden to healthcare systems and society worldwide. Novel strategies to separately evaluate, reduce, and improve the quality for the emergent management of colorectal cancer should be explored as a global health target.


Colorectal cancer Emergency surgery Economic impact Ileostomy Colostomy 


  1. 1.
    Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–86. Scholar
  2. 2.
    Tilson L, Sharp L, Usher C, Walsh C, Whyte S, O’Ceilleachair A, et al. Cost of care for colorectal cancer in Ireland: a health care payer perspective. Eur J Health Econ. 2012;13(4):511–24. Scholar
  3. 3.
    Redaelli A, Cranor CW, Okano GJ, Reese PR. Screening, prevention and socioeconomic costs associated with the treatment of colorectal cancer. Pharmacoeconomics. 2003;21(17):1213–38.CrossRefGoogle Scholar
  4. 4.
    Haider AH, Obirieze A, Velopulos CG, Richard P, Latif A, Scott VK, et al. Incremental cost of emergency versus elective surgery. Ann Surg. 2015;262(2):260–6. Scholar
  5. 5.
    Shah NA, Halverson J, Madhavan S. Burden of emergency and non-emergency colorectal cancer surgeries in West Virginia and the USA. J Gastrointest Cancer. 2013;44(1):46–53. Scholar
  6. 6.
    McArdle CS, Hole DJ. Emergency presentation of colorectal cancer is associated with poor 5-year survival. Br J Surg. 2004;91(5):605–9. Scholar
  7. 7.
    Kelly M, Sharp L, Dwane F, Kelleher T, Comber H. Factors predicting hospital length-of-stay and readmission after colorectal resection: a population-based study of elective and emergency admissions. BMC Health Serv Res. 2012;12:77. Scholar
  8. 8.
    Corral J, Castells X, Molins E, Chiarello P, Borras JM, Cots F. Long-term costs of colorectal cancer treatment in Spain. BMC Health Serv Res. 2016;16:56. Scholar
  9. 9.
    Chen TM, Huang YT, Wang GC. Outcome of colon cancer initially presenting as colon perforation and obstruction. World J Surg Oncol. 2017;15(1):164. Scholar
  10. 10.
    Ghazi S, Berg E, Lindblom A, Lindforss U, Low-Risk Colorectal Cancer Study G. Clinicopathological analysis of colorectal cancer: a comparison between emergency and elective surgical cases. World J Surg Oncol. 2013;11:133. Scholar
  11. 11.
    Koh FH, Tan KK, Tsang CB, Koh DC. Laparoscopic versus an open colectomy in an emergency setting: a case-controlled study. Ann Coloproctol. 2013;29(1):12–6. Scholar
  12. 12.
    Song X, Zhao Z, Barber B, Gregory C, Cao Z, Gao S. Cost of illness in patients with metastatic colorectal cancer. J Med Econ. 2011;14(1):1–9. Scholar
  13. 13.
    Gordon LG, Beesley VL, Lynch BM, Mihala G, McGrath C, Graves N, et al. The return to work experiences of middle-aged Australian workers diagnosed with colorectal cancer: a matched cohort study. BMC Public Health. 2014;14:963. Scholar
  14. 14.
    Vicente-Herrero MT, Terradillos-Garcia MJ, Ramirez-Iniguez-de la Torre MV, Capdevila-Garcia LM, Lopez-Gonzalez AA. [Colorectal cancer in Spain: temporary disability and preventive occupational strategies]. Rev Gastroenterol Mex 2013;78(2):75–81. doi: Scholar
  15. 15.
    Arezzo A, Passera R, Lo Secco G, Verra M, Bonino MA, Targarona E, et al. Stent as bridge to surgery for left-sided malignant colonic obstruction reduces adverse events and stoma rate compared with emergency surgery: results of a systematic review and meta-analysis of randomized controlled trials. Gastrointest Endosc. 2017;86(3):416–26. Scholar
  16. 16.
    Flor-Lorente B, Baguena G, Frasson M, Garcia-Granero A, Cervantes A, Sanchiz V, et al. Self-expanding metallic stent as a bridge to surgery in the treatment of left colon cancer obstruction: cost-benefit analysis and oncologic results. Cir Esp. 2017;95(3):143–51. Scholar
  17. 17.
    Singh H, Latosinsky S, Spiegel BM, Targownik LE. The cost-effectiveness of colonic stenting as a bridge to curative surgery in patients with acute left-sided malignant colonic obstruction: a Canadian perspective. Can J Gastroenterol. 2006;20(12):779–85.CrossRefGoogle Scholar
  18. 18.
    Qaseem A, Denberg TD, Hopkins RH Jr, Humphrey LL, Levine J, Sweet DE, et al. Screening for colorectal cancer: a guidance statement from the American College of Physicians. Ann Intern Med. 2012;156(5):378–86. Scholar
  19. 19.
    Anantha RV, Brackstone M, Parry N, Leslie K. An acute care surgery service expedites the treatment of emergency colorectal cancer: a retrospective case-control study. World J Emerg Surg. 2014;9(1):19. Scholar
  20. 20.
    Huddart S, Peden CJ, Swart M, McCormick B, Dickinson M, Mohammed MA, et al. Use of a pathway quality improvement care bundle to reduce mortality after emergency laparotomy. Br J Surg. 2015;102(1):57–66. Scholar
  21. 21.
    Cohen RD. The quality of life in patients with Crohn’s disease. Aliment Pharmacol Ther. 2002;16(9):1603–9.CrossRefGoogle Scholar
  22. 22.
    Dunn J, Lynch B, Aitken J, Leggett B, Pakenham K, Newman B. Quality of life and colorectal cancer: a review. Aust N Z J Public Health. 2003;27(1):41–53.CrossRefGoogle Scholar
  23. 23.
    Hunt SM, McKenna SP, McEwen J, Williams J, Papp E. The Nottingham Health Profile: subjective health status and medical consultations. Soc Sci Med A. 1981;15(3 Pt 1):221–9.PubMedGoogle Scholar
  24. 24.
    Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–83.CrossRefGoogle Scholar
  25. 25.
    Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, et al. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11(3):570–9. Scholar
  26. 26.
    Sprangers MA, Cull A, Bjordal K, Groenvold M, Aaronson NK. The European Organization for Research and Treatment of Cancer. Approach to quality of life assessment: guidelines for developing questionnaire modules. EORTC Study Group on Quality of Life. Qual Life Res. 1993;2(4):287–95.CrossRefGoogle Scholar
  27. 27.
    Ward WL, Hahn EA, Mo F, Hernandez L, Tulsky DS, Cella D. Reliability and validity of the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) quality of life instrument. Qual Life Res. 1999;8(3):181–95.CrossRefGoogle Scholar
  28. 28.
    Sprangers MA, te Velde A, Aaronson NK. The construction and testing of the EORTC colorectal cancer-specific quality of life questionnaire module (QLQ-CR38). European Organization for Research and Treatment of Cancer Study Group on Quality of Life. Eur J Cancer. 1999;35(2):238–47.CrossRefGoogle Scholar
  29. 29.
    Whistance RN, Conroy T, Chie W, Costantini A, Sezer O, Koller M, et al. Clinical and psychometric validation of the EORTC QLQ-CR29 questionnaire module to assess health-related quality of life in patients with colorectal cancer. Eur J Cancer. 2009;45(17):3017–26. Scholar
  30. 30.
    Bowyer A, Jakobsson J, Ljungqvist O, Royse C. A review of the scope and measurement of postoperative quality of recovery. Anaesthesia. 2014;69(11):1266–78. Scholar
  31. 31.
    Lohsiriwat V. Enhanced recovery after surgery vs conventional care in emergency colorectal surgery. World J Gastroenterol. 2014;20(38):13950–5. Scholar
  32. 32.
    You YN, Chua HK, Nelson H, Hassan I, Barnes SA, Harrington J. Segmental vs. extended colectomy: measurable differences in morbidity, function, and quality of life. Dis Colon Rectum. 2008;51(7):1036–43. Scholar
  33. 33.
    Yde J, Larsen HM, Laurberg S, Krogh K, Moeller HB. Chronic diarrhoea following surgery for colon cancer-frequency, causes and treatment options. Int J Colorectal Dis. 2018;33:683. Scholar
  34. 34.
    Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36(1):77–97.CrossRefGoogle Scholar
  35. 35.
    Martellucci J. Low anterior resection syndrome: a treatment algorithm. Dis Colon Rectum. 2016;59(1):79–82. Scholar
  36. 36.
    Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg. 2012;255(5):922–8. Scholar
  37. 37.
    Temple LK, Bacik J, Savatta SG, Gottesman L, Paty PB, Weiser MR, et al. The development of a validated instrument to evaluate bowel function after sphincter-preserving surgery for rectal cancer. Dis Colon Rectum. 2005;48(7):1353–65. Scholar
  38. 38.
    Ridtitid W, Siripun A, Rerknimitr R. Stricture at colorectal anastomosis: to dilate or to incise. Endosc Int Open. 2018;6(3):E340–E1. Scholar
  39. 39.
    Shabbir J, Britton DC. Stoma complications: a literature overview. Colorectal Dis. 2010;12(10):958–64. Scholar
  40. 40.
    Kann BR. Early stomal complications. Clin Colon Rectal Surg. 2008;21(1):23–30. Scholar
  41. 41.
    Bafford AC, Irani JL. Management and complications of stomas. Surg Clin North Am. 2013;93(1):145–66. Scholar
  42. 42.
    Krishnamurty DM, Blatnik J, Mutch M. Stoma complications. Clin Colon Rectal Surg. 2017;30(3):193–200. Scholar
  43. 43.
    Wade BE. Colostomy patients: psychological adjustment at 10 weeks and 1 year after surgery in districts which employed stoma-care nurses and districts which did not. J Adv Nurs. 1990;15(11):1297–304.CrossRefGoogle Scholar
  44. 44.
    Cotrim H, Pereira G. Impact of colorectal cancer on patient and family: implications for care. Eur J Oncol Nurs. 2008;12(3):217–26. Scholar
  45. 45.
    Grant M, Ferrell B, Dean G, Uman G, Chu D, Krouse R. Revision and psychometric testing of the City of Hope Quality of Life-Ostomy Questionnaire. Qual Life Res. 2004;13(8):1445–57. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Aleix Martínez-Pérez
    • 1
  • Carmen Payá-Llorente
    • 2
  • Arturo García-Lozano
    • 3
  1. 1.Colorectal Surgery Unit, Department of General and Digestive SurgeryHospital Universitario Doctor PesetValenciaSpain
  2. 2.Department of General and Digestive SurgeryHospital Universitario Doctor PesetValenciaSpain
  3. 3.Hospital Universitario Doctor PesetValenciaSpain

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