Impact of emergency presentation on early surgical and oncological outcomes in rectosigmoid cancer: a single-center retrospective analysis.

Abstract

Background: Cancers of the rectosigmoid region account for a significant portion of colorectal cancers malignancies and are associated with higher rates of emergency presentation compared to other colorectal cancers. This study aims to compare emergency and elective presentations of rectosigmoid junction cancers in terms of surgical and pathological outcomes.

Methods: Between 2021 and 2025, a total of 321 patients who underwent surgery for rectosigmoid cancer were retrospectively evaluated. Patients were categorized into two groups based on the nature of their hospital admission: emergency (n=76) and elective (n=245). Demographic characteristics (age, gender, American Society of Anesthesiologists Physical Status Classification System [ASA] score), surgical details (approach, tumor location, type of operation, operative duration), postoperative complications (Clavien-Dindo classification, length of hospital stay), and pathology results (perineural invasion, lymphovascular invasion, tumor (T) and nodal (N) stage, lymph node count) were analyzed.

Results: The mean age in the emergency group (67.93±13.36 years) was higher than in the elective group (64.42±11.65 years) (p=0.027). The emergency group had a higher frequency of open surgical approaches (p<0.001), sigmoid tumors (p<0.001), and resection with colostomy procedures (p<0.001), while the elective group had higher rates of anastomosis (p<0.001). Postoperative complications, operation duration, and length of hospital stay were all significantly greater in the emergency group (p<0.001, p<0.001, and p=0.018, respectively). Pathologically, the emergency group showed higher rates of perineural invasion (p<0.001), lymphovascular invasion (p=0.006), advanced T and N stages (p<0.001 and p=0.006, respectively), and a higher number of positive lymph nodes (p=0.006). However, there was no difference between the groups in the total number of lymph nodes removed (p=0.323).

Conclusion: Despite the inherent challenges of emergency presentation, adherence to principles such as complete mesocolic excision and adequate lymphadenectomy in both groups resulted in comparable pathological outcomes, demonstrating the feasibility of maintaining oncologic standards even in emergency settings. This study shows that, despite their complexity, emergency presentations do not preclude oncologically radical resections when managed with standardized protocols.