Comparative Oncologic Outcomes between Emergency and Elective Surgery in Colon Cancer Patients in Suratthani Hospital: A Retrospective Cohort Study

Thanakorm  Orapan

doi:10.64387/tjs.2026.276777

Authors

Thanakorm Orapan Department of Surgery, Surat Thani Hospital. Surat Thani, Thailand.

DOI:

https://doi.org/10.64387/tjs.2026.276777

Keywords:

Selected:Colon cancer, Emergency surgery, Obstruction, Perforation, Survival, Elective surgery

Abstract

Background: Colon cancer remains a major cause of morbidity and mortality worldwide. Emergency surgical presentations, such as obstruction or perforation, are associated with poorer outcomes compared to elective surgery. This study aimed to compare the clinical and oncologic outcomes between elective and emergency surgeries in colon cancer patients.

Materials and Methods: A retrospective cohort study was conducted at Suratthani Hospital, Thailand, including patients who underwent colon cancer surgery between January 2016 and December 2020. Patients were categorized into elective and emergency surgery groups (obstruction or perforation). Exclusion criteria included rectal cancer, stage IV disease, iatrogenic perforation, and incomplete follow-up. Demographics, tumor characteristics, treatments, and outcomes were analyzed. Survival was assessed using Kaplan-Meier and Cox regression analyses. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated using multivariable Cox regression to adjust for unbalanced baseline characteristics.

Results: Of the 191 included patients, 104 (54.5%) underwent elective surgery, and 87 (45.5%) underwent emergency surgery (75 obstruction, 12 perforation). The emergency group had significantly higher comorbidity rates (p = 0.032), colostomy rates (p < 0.001), and longer hospital stays (p = 0.006). Five-year overall survival was significantly lower in the emergency group (HR 1.58, 95% CI: 1.09–2.29) compared to the elective group (reference), particularly in perforation cases (HR 2.85, 95% CI: 1.62–5.02; p < 0.001). Multivariate analysis identified perforation, obstruction, comorbidity, stage III disease, poor/mucinous histology, and absence of adjuvant chemotherapy as independent predictors of worse survival.

Conclusion: Emergency surgery for colon cancer, especially for perforation, is associated with worse oncologic outcomes compared to elective procedures. Early detection, timely elective intervention, and adjuvant chemotherapy are crucial for improving survival in colon cancer patients.

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