Comparative Outcomes of Colorectal Cancer Patients Undergoing Elective and Emergency Surgeries: A Propensity Score Matched Cohort Study

Background: Colorectal cancer (CRC) is the third most common malignancy and the second leading cause of cancer-related mortality worldwide. A significant proportion of patients present as emergencies with obstruction, perforation, or bleeding, necessitating emergency colorectal surgery (EMCRS). This study aimed to compare the outcomes of patients undergoing EMCRS with those undergoing elective colorectal surgery (ELCRS). Methods: This retrospective-prospective cohort study included patients undergoing curative CRC resections at a tertiary center in Southern India between January 2010 and June 2022. Patients with metastatic disease or palliative procedures were excluded. Propensity score matching (PSM) was performed (1:1) based on age, sex, tumor location, and stage. Outcomes assessed included postoperative complications, inpatient mortality, disease-free survival (DFS), and overall survival (OS). Results: Among 558 patients (106 EMCRS, 305 ELCRS), 106 matched pairs were analysed. Before PSM, EMCRS had significantly higher morbidity (71.4% vs. 40.7%) and mortality (17.9% vs. 2.3%). After PSM, EMCRS continued to show increased severe complications (Clavien-Dindo IV/V), sepsis, pulmonary and cardiac complications, and higher inpatient mortality (17.9% vs. 0.9%). However, long-term outcomes were not significantly different (DFS: 58±3 vs. 55.5±4.7 months, p=0.19; OS: 67.5±2.9 vs. 69.7±4.9 months, p=0.391). Conclusion: EMCRS is linked to significantly worse short-term outcomes. The difference in long-term survival appears to stem from advanced disease at presentation rather than the emergency nature of surgery. Enhanced screening and preoperative optimization strategies may help improve patient outcomes