Survival Following Colorectal Cancer Surgery in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Background and Objectives: Surgery is the mainstay of treatment for localized colorectal cancer (CRC); however, little is known about survival outcomes following CRC surgery in low- and middle-income countries (LMICs). Here, we examine the available data on long-term outcomes following CRC resections in LMICs. Methods: A systematic review and meta-analysis were conducted on primary research studies reporting survival data after CRC resection with curative intent in LMICs. Disease-free survival (DFS) and overall survival (OS) data were extracted, and random effects modelling was used to estimate the pooled survival rates. Results: One hundred and fifty-four studies representing 20,589 CRC patients were analyzed. Notably, only 27 (20%) of the 137 LMICs were represented in the literature. The pooled 5-year OS estimate was 88% (95% CI: 77–95), 76% (69–81), and 57% (49–64) for Stages I, II, and III, respectively. 5-year DFS estimates were 82% (71–90), 76% (67–84), and 59% (51–65) for stages I, II, and III, respectively. Combined OS and DFS estimates for all three stages were 76% and 69%, respectively. Survival rates varied considerably across the included studies and between income groups. Conclusions: With the rising incidence of CRC globally, our work highlights the dearth of data on long-term outcomes following CRC operations in most LMICs and emphasizes the urgent need for research capacity building.