Background: Colorectal cancer (CRC) is a surgical disease that ranks among leading causes of global deaths, but little is known about survival outcomes following CRC surgery in low- and middle-income countries (LMICs). In this study, we sought to review all published literature on long-term outcomes following CRC resections in LMICs. Methods: We completed a systematic review of original research articles presenting survival outcomes after CRC resection with curative intent in LMICs. Databases searched included PubMed, Web of Science, Embase, and Global Index Medicus. Country income groupings were determined by 2020 World Bank data. We excluded articles involving pediatric populations (<18 years), non-primary colorectal cancers, benign disease, and endoscopic/transanal resection only. Articles published before 2005 or without English full text were also excluded. Abstracts and full texts were assessed for eligibility by two independent reviewers; conflicts were resolved by a third reviewer. Data from China dominated the published literature and were excluded from final analysis. Survival data were extracted for 5-year disease free survival (DFS) and overall survival (OS). Results: Our search returned 29,134 articles. After automated and manual deduplication, 18,849 abstracts were assessed for eligibility. Following abstract and full-text review, 583 articles met the inclusion criteria for the study. Table 1 shows the most-represented countries and their associated income levels. In total, 1/27 low-income countries, 11/55 lower-middle income countries, and 16/55 upper-middle income countries were represented, which accounted for 0.3%, 12.9% and 86.8% of all included articles, respectively. The majority of articles were from China (379/583; 65%). Excluding data from China, 5-year disease DFS and OS varied significantly across included studies: Stage I = 64-100% DFS and 70-100% OS; Stage II = 75-94% DFS and 50-94% OS; Stage III = 34-87% DFS and 20-93% OS; Stages I-III combined = 53-86% DFS and 29-97% OS. Conclusions: There is a dearth of data on long-term outcomes following CRC operations in LMICs, especially among low-income countries. OS ranges markedly by country income group highlighting global disparities in cancer care. Our review emphasizes a dire need for cancer research capacity building in LMICs.

*Low income (L), Lower middle income (LM), Upper middle income (UM).