Abstract / Summary
Introduction COVID-19 disrupted colorectal cancer (CRC) screening and diagnostic services, raising concerns that delayed diagnosis would increase emergency presentations and advanced disease. This study evaluated temporal changes in emergency CRC presentation, tumour characteristics, and management within a regional Australian health service. Methods A retrospective cohort study included adults presenting emergently with newly diagnosed CRC between January 2019 and July 2023. Absolute emergency presentation volumes and emergency presentations relative to elective CRC resections were examined before and during COVID-19 restrictions. Temporal trends in tumour characteristics and management were assessed using logistic regression, with secondary analyses adjusted for age and sex. Results A total of 149 patients presented emergently with CRC. Absolute emergency presentation volumes remained stable across the complete calendar years studied, with 30 cases in 2019, 28 in 2020, 32 in 2021, and 30 in 2022. Emergency presentations also remained stable relative to elective CRC resections, accounting for 15.3% of CRC surgical activity in 2019 compared with 15.2% during the COVID-19 restriction period (2020-2022; odds ratio (OR) 0.99, 95% confidence interval (CI) 0.63-1.55; p = 0.970). Increasing calendar year was independently associated with greater odds of high-grade disease (adjusted OR (aOR) 1.39 per year, 95% CI 1.07-1.82; p = 0.015) and stoma formation at index presentation (aOR 1.37 per year, 95% CI 1.04-1.80; p = 0.026), although the latter association was influenced by a marked increase in stoma formation in 2022. Stage IV and metastatic disease were more frequent in later years but did not demonstrate statistically significant temporal associations. Conclusion Emergency CRC presentation volumes remained stable during the COVID-19 restriction period within this regional Australian health service, alongside relatively preserved elective CRC surgical activity. Although increasing calendar year was associated with high-grade disease and stoma formation, the stoma association was influenced by a marked increase in 2022 and should be interpreted cautiously. These findings suggest that presentation frequency alone may not capture changes in the characteristics and management complexity of emergency CRC.