Presentation and Outcomes of Patients with Colorectal Malignancies Undergoing Emergency Surgery – Experience from a Tertiary Care Centre in India

Background: Patients with colorectal cancer (CRC) presenting acutely to the emergency department vary in their physiological statuses and disease stages, necessitating a tailored surgical approach. This study assessed the presentation, surgical management, and perioperative outcomes of emergency CRC. Methods: A retrospective analysis was conducted on data collected from 44 patients presenting with acute CRC at the Postgraduate Institute of Medical Education and Research, Chandigarh, India, from January 2020 to January 2022. Presentation, pathological, and surgical outcomes were assessed. Results: The mean age at presentation was 53.04±15.04 years (19-77). Intestinal obstruction was the most common presentation. A total of 24 colorectal resections (54.6%) were performed, along with 14 diversion colostomies (31.8%) and 6 diversion ileostomies (13.6%). The length of hospital stay (LOH) was 8.5±5.6 days, with a discharge rate of 77%. The 30-day mortality rate was 9.09%, and the readmission rate was 2.27%. A comparison of tumor resection versus non-resection procedures revealed statistically significant differences in mean age and LOH (P=0.019 and P=0.032, respectively). Tumor, Node, and Metastasis (TNM) staging was completed in 26 patients (56.5%); among them, 3 had stage I (11%), 8 had stage II (31%), 7 had stage III (27%), and 8 had stage IV (31%) disease. Among all patients, 23 (50%) had T3 disease, and 29 (63%) had moderately differentiated tumors. The median time to start adjuvant treatment was 3.5 months after surgery. Conclusion: This single-center retrospective study found that acute presentations of colorectal cancer in the emergency department were commonly associated with advanced-stage disease and significant physiological derangements. These factors presented considerable challenges to surgical approaches and perioperative management, potentially impacting long-term outcomes. Further studies are needed to assess the generalizability of these findings.