Emergency Surgery Independently Predicts Postoperative Recurrence in Patients with Pathologic T3N0M0 Colon Cancer: A Retrospective Single-Center Cohort Study

Background and Objectives: Pathologic stage IIA (T3N0M0) colon cancer represents a heterogeneous subgroup of stage II disease with variable recurrence risk despite similar TNM staging. Although several clinicopathological high-risk features are incorporated into current treatment guidelines, the independent prognostic significance of emergency surgery remains incompletely understood. This study aimed to identify clinicopathological predictors of postoperative recurrence, with particular emphasis on the prognostic impact of emergency surgery. Materials and Methods: This retrospective single-center cohort study included 118 patients with pathologic T3N0M0 colon adenocarcinoma who underwent curative-intent surgery. Demographic, clinicopathological, treatment, and follow-up data were analyzed. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of recurrence. Because adjuvant chemotherapy was not randomly assigned, a sensitivity analysis including adjuvant chemotherapy was conducted to address confounding by indication. Disease-free survival (DFS) was evaluated using the Kaplan–Meier method. Results: During follow-up, recurrence occurred in 15 patients (12.7%). Patients with recurrence underwent emergency surgery significantly more frequently than those without recurrence (60.0% vs. 20.4%, p = 0.003). Perineural invasion and adjuvant chemotherapy were associated with recurrence in univariable analyses. In the primary multivariable model, emergency surgery remained an independent predictor of recurrence (OR 5.508, 95% CI 1.726–17.576; p = 0.004), whereas perineural invasion showed only borderline significance. In the sensitivity analysis, emergency surgery remained independently associated with recurrence (OR 4.079, 95% CI 1.207–13.779; p = 0.024), while adjuvant chemotherapy was no longer independently associated with recurrence. Kaplan–Meier analysis demonstrated significantly shorter DFS among patients undergoing emergency surgery (log-rank p = 0.002). Conclusions: Among patients with pathologic T3N0M0 colon cancer, the need for emergency surgery was associated with a higher risk of recurrence after adjustment for other clinicopathological factors. Emergency presentation may therefore serve as an additional marker for identifying patients at increased postoperative risk. Further prospective multicenter research is needed to confirm this association and to explore its potential value when combined with molecular biomarkers for individualized postoperative management.