Emergency right colectomy for colon cancer: anastomosis versus diversion and factors associated with anastomotic leakage

In emergency right colectomy for colon cancer, the decision the surgeon faces is not only how to fashion the anastomosis but whether to anastomose at all or to divert. Evidence to guide this decision is scarce, particularly from resource-limited settings. We compared patients managed with primary anastomosis versus diversion, explored factors associated with anastomotic leak (AL) among patients selected for primary anastomosis. Single-center retrospective cohort (2010–2025) of 100 consecutive emergency right colectomies for colon cancer: 74 with primary ileocolic anastomosis (Group A) and 26 with diversion/no anastomosis (Group B). We compared baseline and operative characteristics between groups and explored factors associated with anastomotic leak among patients receiving primary anastomosis using Firth penalized logistic regression because of sparse events. No clinical risk score was developed. The indications for emergency surgery were obstruction in 73 patients, perforation in 19, bleeding in 5, and ischemia in 3. Among the 74 patients receiving anastomosis, 8 (10.8%) developed an anastomotic leak. Peritoneal contamination showed the strongest exploratory association with leak on univariate and multivariable Firth regression (multivariable OR 8.58, 95% CI 1.77–41.63; p = 0.008). APACHE II and MPI were retrospectively calculable in 76 and 82 patients, respectively; among anastomosed patients, values were numerically higher in patients with leak but did not reach statistical significance. In this retrospective cohort, diversion was preferentially used in patients with a higher-risk clinical and operative profile. Among patients selected for primary anastomosis, the observed leak rate was 10.8%. Peritoneal contamination was the strongest exploratory correlate of leak. The findings are hypothesis-generating and should not be interpreted as a validated prediction rule or as evidence that diversion is superior for individual patients.