The impact of economic crisis, COVID-19, and the Beirut Blast on colorectal cancer patients in Lebanon: A trend to operate more late-stage complex cases.

BACKGROUND

The convergence of the economic crisis, COVID-19 pandemic, and Beirut Blast has precipitated unprecedented challenges for the healthcare system in Lebanon, particularly for cancer patients. Amidst these crises, our study evaluates its contribution to a concerning trend of operating on more late-stage and complex colorectal cancer (CRC) cases.

METHODS

We included 155 patients operated for CRC between 2017 and 2023. Patients age; sex; operation type (emergency or elective); tumor size, grade, and location; tumour, node, metastasis stage; lymphatic, vascular and perineural invasions; American Society of Anesthesiologists (ASA) score, presentation and previous history, and complications were examined.

RESULTS

Surgical outcomes remained relatively consistent before and after the crisis. However, there was a notable increase, with patients being 3.59 times more likely to undergo resection of adjacent organs in metastatic disease post-crisis. Patient characteristics also exhibited notable shifts, with a 9.60-fold increase in the likelihood of having an ASA score of at least 2 after the crisis. Additionally, there was a 5.36-fold decrease in the odds of patients undergoing a colonoscopy before their diagnostic one post-crisis. Preoperative carcinoembryonic antigen levels were significantly elevated post-crisis compared to pre-crisis levels. Pathological findings revealed increased odds of perineural, vascular, and lymphatic invasion post-crisis. Additionally, there was a notable increase in the likelihood of hepatic synchronous metastases post-crisis. Furthermore, a trend to operate on complicated diseases was noted with an increased number of colostomies.

CONCLUSION

The economic crisis in Lebanon has profoundly affected early intervention and comprehensive treatment for CRC patients, resulting in a concerning rise in late-stage cases requiring surgical intervention.