{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T12:13:23Z","timestamp":1784031203704,"version":"3.55.0"},"reference-count":20,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2024,8,25]],"date-time":"2024-08-25T00:00:00Z","timestamp":1724544000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The convergence of the economic crisis, COVID\u201019 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\u2010stage and complex colorectal cancer (CRC) cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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\u2010crisis. Patient characteristics also exhibited notable shifts, with a 9.60\u2010fold increase in the likelihood of having an ASA score of at least 2 after the crisis. Additionally, there was a 5.36\u2010fold decrease in the odds of patients undergoing a colonoscopy before their diagnostic one post\u2010crisis. Preoperative carcinoembryonic antigen levels were significantly elevated post\u2010crisis compared to pre\u2010crisis levels. Pathological findings revealed increased odds of perineural, vascular, and lymphatic invasion post\u2010crisis. Additionally, there was a notable increase in the likelihood of hepatic synchronous metastases post\u2010crisis. Furthermore, a trend to operate on complicated diseases was noted with an increased number of colostomies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The economic crisis in Lebanon has profoundly affected early intervention and comprehensive treatment for CRC patients, resulting in a concerning rise in late\u2010stage cases requiring surgical intervention.<\/jats:p><\/jats:sec>","DOI":"10.1002\/wjs.12321","type":"journal-article","created":{"date-parts":[[2024,8,25]],"date-time":"2024-08-25T22:48:08Z","timestamp":1724626088000},"page":"2376-2382","source":"Crossref","is-referenced-by-count":4,"title":["The impact of economic crisis, COVID\u201019, and the Beirut Blast on colorectal cancer patients in Lebanon: A trend to operate more late\u2010stage complex cases"],"prefix":"10.1002","volume":"48","author":[{"given":"Michael","family":"Osseis","sequence":"first","affiliation":[{"name":"Faculty of Medicine Department of Digestive Surgery H\u00f4tel\u2010Dieu de France Hospital Saint Joseph University of Beirut  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farid Abi","family":"Habib","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Department of Digestive Surgery H\u00f4tel\u2010Dieu de France Hospital Saint Joseph University of Beirut  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Al Rachid","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Department of Digestive Surgery H\u00f4tel\u2010Dieu de France Hospital Saint Joseph University of Beirut  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"El Hadi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Lebanese American University Medical Center  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Kazan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Department of Digestive Surgery H\u00f4tel\u2010Dieu de France Hospital Saint Joseph University of Beirut  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6076-004X","authenticated-orcid":false,"given":"Christian","family":"Mouawad","sequence":"additional","affiliation":[{"name":"Department of Digestive Surgery Centre Hospitalier Intercommunal de Villeneuve\u2010Saint\u2010Georges  Greater Paris Metropolis France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghassan","family":"Chakhtoura","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Department of Digestive Surgery H\u00f4tel\u2010Dieu de France Hospital Saint Joseph University of Beirut  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Noun","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Department of Digestive Surgery H\u00f4tel\u2010Dieu de France Hospital Saint Joseph University of Beirut  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,8,25]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/1073274821996869"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.2217\/fon\u20102020\u20100927"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/10732748211041221"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.3332\/ecancer.2022.1359"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2018.36.15_suppl.e18917"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0262048"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0222570"},{"key":"e_1_2_13_9_1","unstructured":"Doyle D. 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