A comparative analysis of preoperative, intraoperative, and tumor characteristics in emergency and elective right-sided colonic surgery.

Abstract

Objective: This study aimed to compare preoperative, intraoperative, and tumor characteristics between patients undergoing emergency and elective surgery for right-sided colon cancer. Despite the worsened prognosis of emergency colorectal cancer cases, studies on right colon cancer remain limited.

Material and methods: This retrospective study included 356 patients who underwent surgery for right-sided colon cancer between January 2015 and April 2023. Patients were categorized into emergency (n=93) and elective (n=263) groups. Demographic data, tumor characteristics, and surgical details were analyzed. Binary logistic regression was applied to identify independent predictors of emergency surgery.

Results: Age (p=0.435) and gender distribution (p=0.853) were similar between groups. However, American Society of Anesthesiologists (ASA) scores were higher in the emergency group (p=0.001), while Charlson comorbidity index (CCI) scores showed no significant difference (p=0.169). T4 (p<0.001), N1 (p=0.008), and M1 stages (p<0.001) were significantly more frequent in the emergency group, along with higher tumor perforation rates (34.4% vs. 1.9%, p<0.001). Open surgery was more common in the emergency group (p=0.005). While total lymph node yield was similar (p=0.501), the number of metastatic lymph nodes was higher in the emergency group (p=0.008). Logistic regression identified higher ASA score, advanced T, N, M stages, tumor perforation, and tumor size as predictors of emergency surgery.

Conclusion: Patients undergoing emergency surgery for right colon cancer have more advanced disease, higher tumor perforation rates, and poorer prognostic factors. Laparoscopic surgery was less utilized, which indicates technical challenges. Early diagnosis and screening strategies may reduce emergency interventions and improve outcomes.