A retrospective cohort of 191 colon-cancer patients operated on in 2016-2020 found worse five-year overall survival among 87 emergency versus 104 elective cases (adjusted HR 1.58), with perforation carrying HR 2.85. The findings reflect disease severity and baseline differences as well as care pathway; they do not show that emergency surgery itself caused all excess risk.
Key findings
- There were 104 elective cases (54.5%) and 87 emergency cases (45.5%): 75 obstructions and 12 perforations. Emergency patients had more comorbidity, colostomy and longer stays. Five-year overall mortality HR was 1.58 (95% CI 1.09-2.29); perforation HR was 2.85 (95% CI 1.62-5.02). Comorbidity, stage III, poor/mucinous histology and no adjuvant chemotherapy also predicted worse survival.
Why this matters globally
Many patients worldwide still present with obstruction or perforation. Thai provincial data reinforce the need for screening, referral and cancer pathways that reduce emergency presentation, especially outside major centres.
Thai researcher contribution
Surat Thani Hospital contributed real-world southern Thai evidence, broadening cancer-planning data beyond metropolitan tertiary centres.
Limitations to consider
This was a retrospective single-centre study; only 12 patients had perforation, yielding uncertainty. Residual confounding and selection bias remain despite adjustment. Excluding stage IV and incomplete follow-up limits generalisability. Lack of adjuvant therapy may reflect health or complications rather than an independent causal effect.