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

Comparative Outcomes of Colorectal Cancer Patients Undergoing Elective and Emergency Surgeries: A Propensity Score Matched Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparative Outcomes of Colorectal Cancer Patients Undergoing Elective and Emergency Surgeries: A Propensity Score Matched Cohort Study Kedareswar M, Reddy Abhinaya P, Vishnu Prasad N R, Avinash S R, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7534081/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Jan, 2026 Read the published version in Journal of Gastrointestinal Cancer → Version 1 posted 10 You are reading this latest preprint version Abstract 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 Colon cancer Colorectal surgery Emergency colorectal surgery Propensity score matching Postoperative outcomes Figures Figure 1 Figure 2 Figure 3 INTRODUCTION Colorectal cancers (CRC) are the third most diagnosed malignancy and the second leading cause of cancer-related mortality worldwide [ 1 , 2 ]. Its global incidence continues to rise, particularly in developing nations, driven by economic growth, westernized lifestyles, and dietary habits marked by increased intake of red meat, fats, and total caloric consumption [ 3 ]. These lifestyle shifts, coupled with increased life expectancy and population growth, are contributing to a growing global burden of CRC. Early-stage CRC often remains asymptomatic or presents with vague, non-specific symptoms. Consequently, many patients seek medical care only when the disease has progressed to an advanced stage [ 4 ]. As a result, approximately 10–30% of CRC cases are diagnosed during emergency presentations, typically involving complications such as intestinal obstruction, perforation, or gastrointestinal bleeding.⁵ for many of these patients, the initial diagnosis, staging, and assessment of resectability occur perioperatively during emergency surgical intervention. Emergency colorectal surgeries (EMCRS) have traditionally been associated with worse short-term outcomes compared to elective colorectal surgeries (ELCRS), with reported postoperative morbidity and mortality rates ranging from 15–50% and 6–15%, respectively—substantially higher than the 4–14% and 1–7% rates observed with ELCRS [ 4 – 6 ]. Additionally, EMCRS is often linked to poorer long-term oncological outcomes, including decreased disease-free survival (DFS) and overall survival (OS). However, other studies have reported no significant differences between the two approaches [ 7 – 9 ]. These inconsistencies may stem from methodological limitations in earlier studies, many of which are observational and include a small proportion of patients undergoing EMCRS. This discrepancy introduces potential confounding biases. While randomized controlled trials would be ideal to minimize such bias, randomizing patients to emergency versus elective surgery is not feasible. In such scenarios, propensity score matching (PSM) offers a robust statistical approach to reduce confounding and simulate randomized comparisons in observational data [ 10 ]. This study aims to evaluate the clinicopathological features, perioperative outcomes, and long-term oncological results of EMCRS versus ELCRS using a PSM cohort. METHODS This study was conducted in the Department of Surgery at a tertiary care center in Southern India. It comprised a combined retrospective and prospective cohort design, covering the period from January 2010 to June 2022. The retrospective arm spanned from January 2010 to April 2021, while the prospective arm extended from April 2021 to June 2022. The study was approved by the Institutional Ethics Committee (IEC) of our institute (JIP/IEC/2021/017). A waiver of consent was granted for retrospectively included participants. The study is also registered with the Clinical Trials Registry – India (CTRI/2021/11/038084) and adhered to the principles of the Declaration of Helsinki. The primary objective of this study was to compare early postoperative morbidity in patients undergoing surgical treatment for CRC in emergency versus elective settings. The secondary objectives included a comparison of histopathological findings of the resected specimens, and inpatient postoperative mortality between the two groups. Additionally, the study aimed to identify the long-term outcomes, including DFS and OS, and were also evaluated to assess the oncological impact of emergency versus elective surgical intervention. All patients from age > 18 years with CRC who underwent surgery in the department of surgery at our institution during the study period were assessed. Those patients in whom resection of the tumour were done with curative intent during the study period were included in the study. Patients treated with palliative intent, such as internal bypass or proximal stoma formation, patients with metastatic disease, gross residual tumour after resection (R2 resection), adenoma or carcinoma in situ in the post operative pathology, patients whose records cannot be retrieved and patients refusing consent in the prospective period were excluded from the study. Our study includes two groups of people undergoing CRC surgery. EMCRS group, which included patients presenting with obstruction, perforation, or bleeding requiring immediate resection, and ELCRS group, consisting of patients undergoing scheduled resection after thorough preoperative evaluation. Perforation was defined as the presence of diffuse or localized peritonitis and/or pneumoperitoneum or localized leak on preoperative radiographs or Computed tomography (CT) scans. Tumors causing obstruction, whether partial or complete, were diagnosed by radiograph or CT and considered as obstructive tumors. Bleeding tumors were identified as those causing severe anemia and hemodynamic instability, requiring emergency resection. Data from the retrospective period (January 2010 to April 2021) were collected from prospectively maintained databases, such as the hospital’s cancer registry, case files, and the hospital information system (HIS). In the prospective period (April 2021 to June 2022), data were collected prospectively, with a minimum follow-up period of 6 months. Complications in the postoperative period were classified according to the Clavien-Dindo grading system [ 11 ], and early postoperative morbidity was defined as complications occurring within 30 days of surgery. Postoperative complications included anastomotic leak, surgical site infection (SSI) [ 12 ], entero-cutaneous fistula, sepsis [ 13 ], prolonged ileus, small bowel obstruction, chest infection, cardiac complications, and deep vein thrombosis (DVT). The total Length of hospital stay was calculated from the day of admission to discharge/death, and the length of postoperative hospital stay was calculated from “the day of surgery to discharge/death.” Inpatient mortality includes the death of a patient that has occurred in the hospital, during the hospital stay of index surgery. Histopathological tumour characters in both groups were compared based on the location, lymphovascular invasion, perineural invasion, circumferential resected margin, lymph node yield, grade, and tumour staging done according to the American joint committee on cancer (AJCC) tumour, node, and metastasis (TNM) classification [ 14 , 15 ]. DFS was defined as the time from surgical resection to cancer recurrence, while OS was defined as the time from surgery to death from any cause. DFS and OS were calculated only for the retrospective period. Demographic data [age, sex, Body mass index (BMI)], clinical details [American Society of Anesthesiologists (ASA) class, comorbidities, smoking status, neoadjuvant therapy], operative data (tumor location, surgical resection type, blood loss, operative time), and postoperative details (complications, length of hospital stay, death, pathological results) were collected. Follow-up data included adjuvant therapy, development of late complications, disease recurrence, survival, and cause of death. Statistical analysis: Statistical analysis was conducted using IBM SPSS version 19.0. The normality of continuous data was assessed using the Kolmogorov–Smirnov test. Continuous variables, such as age, duration of symptoms, BMI, and length of hospital stay, were expressed as means with standard deviations or medians with interquartile ranges (IQR), depending on the data distribution. Categorical variables, including sex, clinical presentation, type of surgery, complications (e.g., SSI, anastomotic leak, sepsis, enterocutaneous fistula, chest infection, DVT, pulmonary embolism), and wound category, were summarized as frequencies and percentages. For continuous variables, differences between groups were analysed using the independent Student t-test or Mann-Whitney U test, as appropriate. Categorical variables were compared using the chi-square (χ2) test or Fisher exact test. Logistic regression was applied to identify factors associated with inpatient mortality, with covariates showing P-values < 0.05 in univariate analysis included in the model. A two-sided P-value < 0.05 was considered statistically significant. Kaplan-Meier curves were used for survival analysis, and log-rank tests were used to compare survival between groups. PSM was performed using a 1:1 nearest neighbour matching algorithm, with standard distance determined by logistic regression. PSM was based on variables such as age, gender, tumor location, and tumour stage. RESULTS A total of 558 patients who underwent surgery for CRC were initially assessed. After applying exclusion criteria 106 EMCRS and 305 ELCRS cases remained. PSM was performed based on age, sex, tumor location, and stage, resulting in 106 matched pairs. These matched cohorts were analyzed for early post-operative complications (n=106 per group) and survival outcomes (n=88 per group) (Fig. 1). Comparison of patient characteristics showed no significant differences in age, gender, BMI, or comorbidities, but EMCRS patients had more proximal tumors, higher rates of poorly differentiated tumors, and more advanced disease stages (Table 1). Table-1: Baseline patient and histopathological characteristics of elective and emergency colorectal cancer surgery groups. Characteristic ELCRS (n=305) EMCRS (n=106) p-value Age (Years) $ 58 (46, 65) 55 (47, 65) 0.76 * Sex Male 171 (56%) 59 (55.6%) 0.94 * Female 134 (44%) 47 (44.4%) BMI (Kg/m 2 ) $ 19.8 (18.6, 20.8) 19.9 (17.8, 20.9) 0.458 * Comorbidities Diabetes Meletus 56 (18.4%) 20 (18.9%) 0.90 * Hypertension 64 (21%) 21 (19.8%) 0.797 * Coronary artery disease 17 (5.6%) 5 (4.7%) 0.736 * Chronic liver disease 1 (0.3%) 2 (1.9%) 0.165 # Chronic kidney disease 6 (2%) 2 (1.9%) 1.000 # Tumour location Caecum 32 (10.5%) 30 (28.3%) <0.001 # Ascending colon 29 (9.5%) 13 (12.3%) Transverse colon 30 (9.8%) 21 (19.8%) Descending colon 18 (5.9%) 14 (13.2%) Sigmoid colon 48 (15.7%) 18 (17%) Rectosigmoid 71 (23.3%) 8 (7.5%) Rectum 77 (25.2%) 2 (1.9%) Histological characters Well differentiated 245 (80.3%) 88 (83%) 0.001 # Moderately differentiated 56 (18.4%) 10 (9.4%) Poorly differentiated 4 (1.3%) 8 (7.5%) Positive Circumferential resected margin; 27 (9.1%) 17 (16.6%) 0.049 Lymphovascular invasion 124 (40.7%) 57 (55.3%) 0.009 Perineural invasion 44 (14.8%) 19 (19.6%) 0.260 Stage I 64 (21%) 15 (14.2%) 0.002 # IIA 98 (32.1%) 22 (20.8%) IIB 10 (3.3%) 7 (6.6%) IIC 0 1 (0.9%) IIIA 12 (3.9%) 1 (0.9%) IIIB 98 (32.1%) 43 (40.6%) IIIC 23 (7.5%) 17 (16%) Median lymph node harvest $ 14 (10, 28) 13 (10, 21) 0.812 # American Society of Anesthesiologists (ASA) class 1 60 (19.7) 18 (17) <0.001 2 186 (61) 44 (41.5) 3 58 (19) 34 (32.1) 4 1 (0.3) 10 (9.4) $-Continuous variables expressed as median (interquartile range). * Pearson Chi-square test; # Fisher’s Exact test; BMI- Body mass index, ELCRS – Elective colorectal surgeries; EMCRS – Emergency colorectal surgeries Postoperative complications were significantly higher in EMCRS, including SSIs (56.6% vs. 38.7%), sepsis (16% vs. 3.9%), and pulmonary complications (25.5% vs. 6.9%) before PSM. After PSM, differences in SSIs and anastomotic leaks were no longer significant, but EMCRS patients continued to experience higher rates of sepsis, pulmonary, and cardiac complications. Severe complications (Clavien-Dindo Grades IV and V) and inpatient mortality were markedly higher in EMCRS, with mortality rates remaining significantly elevated both before (17.9% vs. 2.3%) and after PSM (17.9% vs. 0.9%) (Table 2). Table 2. Comparison of early postoperative outcomes between elective and emergency colorectal cancer surgery groups before and after Propensity Score Matching. Variable Without PSM With PSM ELCRS (n = 305) EMCRS (n = 106) p- value ELCRS (n = 106) EMCRS (n = 106) p- value POSTOPERATIVE COMPLICATIONS Surgical site infection 118 (38.7%) 60 (56.6%) 0.001 * 49 (46.2%) 60 (56.6%) 0.131 * Anastomotic leak 13 (4.3%) 10 (9.4%) 0.046 * 4 (3.8%) 10 (9.4%) 0.097 * Enterocutaneous fistula 0 1 (0.9%) 0.258 # 0 1 (0.9%) 0.316 # Sepsis 12 (3.9%) 17 (16%) <0.001 * 3(2.8%) 17 (16%) 0.001 * Pulmonary complications 21 (6.9%) 27 (25.5%) <0.001 * 8(7.5%) 27 (25.5%) 0.001 * Cardiac complications 4 (1.3%) 17 (16%) <0.001 * 2 (1.9%) 17 (16%) <0.001 * Deep vein thrombosis 2 (0.7%) 1 (0.9%) 1.000 # 0 1 (0.9%) 1.000 # Post operative morbidity 124 (40.7%) 75 (71.4%) <0.001 * 51 (48.1%) 75 (71.4%) 0.001 * Intensive care unit admission 35 (11.5) 46 (43.4) <0.001 * 3 (2.8%) 46 (43.4%) <0.001 * CLAVIEN-DINDO CLASSIFICATION I 101 (33.1%) 37 (34.9%) <0.001 # 44(41.5%) 37 (34.9%) <0.001 * II 8 (2.6%) 13 (12.2%) 1 (0.9%) 14 (13.2%) IIIa 7 (2.3%) 1 (0.9%) 4 (3.8%) 1 (0.9%) IIIb 0 2 (1.9%) 0 2 (1.9%) Iva 1 (0.3%) 3 (2.8%) 0 3 (2.8%) IVb 1 (0.3%) 1 (0.9%) 1(0.9%) 4 (3.8%) V 7 (2.3%) 19 (17.9%) 1 (0.9%) 15 (14.2%) Inpatient mortality 7 (2.3%) 19 (17.9%) <0.001 * 1 (0.9%) 19 (17.9%) <0.001 * * Pearson Chi-square; # Fisher’s Exact test; ELCRS - Elective colorectal surgeries; EMCRS - Emergency colorectal surgeries; PSM - Propensity Score Matching. In terms of survival, before PSM, ELCRS patients had significantly better DFS and OS compared to EMCRS patients (DFS: 73 ± 3 vs. 46 ± 5 months; OS: 89 ± 3 vs. 57 ± 5 months, both p<0.001). However, after PSM, the differences in DFS and OS were not statistically significant (DFS: 58±3 vs. 46±5 months, p=0.19; OS: 67.5±2.9 vs. 57±5 months, p=0.391) (Table 3, Fig. 2 and 3). Table 3. Comparison of oncological outcomes between elective and emergency colorectal cancer surgery groups before and after Propensity Score Matching. Variable Without PSM With PSM ELCRS (n =259) EMCRS (n = 88) p-value ELCRS (n = 88) EMCRS (n = 88) p-value Mean Disease free survival α (months) 73 ± 3 46 ± 5 <0.001 & 58 ± 3.0 46 ± 5 0.19 & Mean Overall survival α (months) 89 ± 3 57 ± 5 <0.001 & 67.5 ± 2.9 57 ± 5 0.391 & * Pearson Chi-square test; & Log Rank test, α- mean± SE; ELCRS – Elective colorectal surgeries; EMCRS – Emergency colorectal surgeries; PSM - Propensity Score DISCUSSION The short-term surgical outcomes and long-term oncological outcomes in patients undergoing emergency versus elective surgery for CRC remain a topic of ongoing debate. While multiple studies have reported unfavorable outcomes following emergency surgery, various confounding factors—such as compromised oncological technique, limited preoperative assessment, and patient frailty—have been proposed to explain the observed differences in long-term survival [ 16 ]. In our cohort study, we assessed both short-term and long-term oncological outcomes in patients with CRC who underwent surgery with curative intent in the emergency and elective settings. Notably, postoperative morbidity and mortality were significantly higher in the EMCRS group compared to the ELCRS group, and these differences remained significant even after PSM. Interestingly, although patients in the EMCRS group had poorer DFS and OS in the unmatched cohort, these differences were not statistically significant after matching. In our study, the most frequent tumor site in the EMCRS group was the right colon, whereas rectal or rectosigmoid tumors were more common in the ELCRS group. This distribution may be attributed to the fact that left-sided tumors tend to produce earlier symptoms, such as altered bowel habits or rectal bleeding, prompting elective evaluation and intervention. In contrast, right-sided tumors often present later due to more insidious symptoms. Another contributing factor could be the need for neoadjuvant therapy in rectal cancers. In emergency settings, surgeons may prefer diversion procedures over definitive resections for rectal tumors, resulting in different management strategies between the two groups. These variations could also reflect regional practice differences, as previous studies have reported inconsistent tumor distributions in emergency settings [ 17 , 18 ]. Additionally, right-sided colon cancers are frequently diagnosed at more advanced stages. A larger tumor burden increases the risk of complications such as obstruction, bleeding, and perforation, common indications for emergency surgery, thereby contributing to the higher rate of emergent presentations [ 19 ]. The EMCRS group in our study had significantly higher in-hospital morbidity and mortality, and these differences persisted even after PSM. This aligns with several previous studies attributing poorer outcomes in emergency surgeries to acute and/or severe physiological derangements at presentation [ 20 – 22 ]. The ASA class, a surrogate marker for physiological status, was significantly higher in the EMCRS group in our cohort, consistent with literature [ 21 , 22 ]. Other Contributing factors include malnutrition, reduced physiological reserve, and the lack of opportunity for prehabilitation in emergency settings. To improve short-term outcomes in this frail patient population, an interdisciplinary approach involving emergency physicians, surgeons, anesthesiologists, nutritionists, and intensivists is essential [ 22 ]. The impact of EMCRS on long-term oncological outcomes remains controversial. Several studies have reported poorer long-term survival in patients undergoing emergency surgery. These outcomes have been attributed to tumor- and patient-related factors such as advanced stage at presentation, inadequate lymph node yield, aggressive tumor biology, incomplete resections, occult metastases, and elevated inflammatory markers like C-reactive protein [ 23 – 26 ]. In our study, although crude DFS and OS were lower in the EMCRS group, these differences were not statistically significant after PSM, indicating comparable long-term outcomes between EMCRS and ELCRS. Similar findings have been reported in other studies that used matched cohorts to compare outcomes among patients with similar baseline characteristics (e.g., age, gender, tumor location, and stage) [ 27 , 28 ]. Another important consideration is adherence to oncological surgical principles during emergency surgeries. Lymph node yield, a surrogate marker for surgical quality and staging accuracy, has shown considerable variation in prior studies, being reported as lower [ 16 ], equal [ 29 ], or even higher [ 27 ] in EMCRS compared to ELCRS. In our study, lymph node harvest was comparable between the two groups, suggesting that oncological standards were maintained even in emergency settings. This, coupled with the use of PSM to ensure comparability of baseline characteristics, the long-term oncological outcomes may not be compromised. Furthermore, our findings support the notion that tumors presenting emergently may share similar biological characteristics with those treated electively, contradicting earlier assumptions that emergency presentations are associated with inherently more aggressive tumor biology [ 24 – 26 ]. Given the higher perioperative risks and advanced presentations associated with EMCRS, enhancing surveillance in high-risk individuals and implementing population-level screening programs is crucial. Early detection through screening can facilitate timely diagnosis and elective surgical planning, ultimately improving outcomes. The profile of CRCs presenting emergently in our cohort also underscores the need for broader awareness and preventive strategies, which may differ from patterns reported in other regions. This study has several limitations. First, the retrospective nature of most of the study period limited access to complete data on adjuvant and neoadjuvant therapies, potentially introducing confounding factors that could influence long-term outcomes. Second, being a single-center study, the generalizability of our findings to other institutions or broader populations may be limited. Third, we did not perform subgroup analyses based on tumor location (colon vs. rectum), which may have provided more detailed insights into site-specific variations in presentation and outcomes. Lastly, the mode of surgery whether open, laparoscopic, or robotic was not accounted for, and this could have impacted both perioperative and oncological outcomes. CONCLUSION EMCRCS carries a higher risk of short-term morbidity and mortality compared with elective surgery, largely due to advanced disease and limited preoperative optimization. However, when baseline characteristics are balanced and oncological principles are maintained, long-term outcomes are comparable between the two groups. These findings emphasize the importance of early detection, standardized surgical care, and multidisciplinary management to improve outcomes in patients presenting emergently. Declarations Funding: The authors did not receive support from any organization for conducting the study or preparing the manuscript or the submitted work . Conflicts of interest/competing interests: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript Ethics approval: The study was approved by the institute Ethical committee ( JIP/IEC/2021/017). Authors’ contribution statements. All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by [Kedareswar], [Reddy Abhinaya P], and [Avinash S R]. The first draft of the manuscript was written by [Reddy Abhinaya P] and [Avinash S R], and all authors commented on previous versions of the manuscript. All authors read and approved of the final manuscript. Data Availability: The datasets generated and/or analyzed during the current study will be made available from the corresponding author on reasonable request. Acknowledgments The authors received no financial support for this study. References Morgan E, Arnold M, Gini A, Lorenzoni V, Cabasag CJ, Laversanne M, et al (2023). Global burden of colorectal cancer in 2020 and 2040: incidence and mortality estimate from GLOBOCAN. Gut 72:338-344. https://doi.org/10.1136/gutjnl-2022-327736 Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al (2024). Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 74:229-263. https://doi.org/10.3322/caac.21834 Bishehsari F, Mahdavinia M, Vacca M, Malekzadeh R, Mariani-Costantini R (2014). Epidemiological transition of colorectal cancer in developing countries: environmental factors, molecular pathways, and opportunities for prevention. 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Cancer 85:2526–2531. https://doi.org/10.1002/(sici)1097-0142(19990615)85:123.0.co;2-3 Antony P, Harnoss JC, Warschkow R, Schmied BM, Schneider M, Tarantino I, Ulrich A (2019) Urgent surgery in colon cancer has no impact on survival. J Surg Oncol 119:1170-1178. https://doi.org/10.1002/jso.25469. Biondo S, Martí-Ragué J, Kreisler E, Parés D, Martín A, Navarro M, Pareja L, Jaurrieta E (2005) A prospective study of outcomes of emergency and elective surgeries for complicated colonic cancer. Am J Surg 189:377-383. https://doi.org/10.1016/j.amjsurg.2005.01.009. Wanis, K. N., Ott, M., Van Koughnett, J. A. M., Colquhoun, P., & Brackstone, M. (2018) Long-term oncological outcomes following emergency resection of colon cancer. Int J Colorectal Dis 33:1525–1532. https://doi.org/10.1007/s00384-018-3109-4 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 06 Jan, 2026 Read the published version in Journal of Gastrointestinal Cancer → Version 1 posted Editorial decision: Revision requested 12 Oct, 2025 Reviews received at journal 07 Oct, 2025 Reviews received at journal 14 Sep, 2025 Reviewers agreed at journal 13 Sep, 2025 Reviewers agreed at journal 13 Sep, 2025 Reviewers agreed at journal 07 Sep, 2025 Reviewers invited by journal 07 Sep, 2025 Editor assigned by journal 07 Sep, 2025 Submission checks completed at journal 04 Sep, 2025 First submitted to journal 04 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7534081","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":511574698,"identity":"9da61c52-1e12-4ca0-858c-13bba9f29c3b","order_by":0,"name":"Kedareswar M","email":"","orcid":"","institution":"Jawaharlal Institute of Postgraduate Medical Education \u0026Research (JIPMER)","correspondingAuthor":false,"prefix":"","firstName":"Kedareswar","middleName":"","lastName":"M","suffix":""},{"id":511574699,"identity":"37174b3b-04bc-4b4f-a9e9-df206716dba9","order_by":1,"name":"Reddy Abhinaya P","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYHACAwkGhgQGBvY2xgcfgFw2dqK18BxjNpwB0sJMtBaJNDZhHhCfkBbz9uaNt3kY0qL5G9LSmG1+bZPnY2Zg/PABjxaZM8eKrXkYcnJnHDh27HFu323DNmYGZskZeLRISOSYSfMwVORuYGxvN87tuc0I1MLGzINPi/wbqBZm9jZpy57b9oS1SPCAtOTkbmBjOybN8ON2ImEtPGnFlnMM0nJnnGFLNuxtuJ3cxszYjN8v7Ic33nhTkZzbP/+Z4YMff27bzm9vPog3xECAiccAymJsA5MNBDQAlfyAM/8QVDwKRsEoGAUjEAAABrRHhDsNC7cAAAAASUVORK5CYII=","orcid":"","institution":"Jawaharlal Institute of Postgraduate Medical Education \u0026Research (JIPMER)","correspondingAuthor":true,"prefix":"","firstName":"Reddy","middleName":"Abhinaya","lastName":"P","suffix":""},{"id":511574700,"identity":"dfe56569-765c-4a24-b868-99fbfc1e943d","order_by":2,"name":"Vishnu Prasad N R","email":"","orcid":"","institution":"Jawaharlal Institute of Postgraduate Medical Education \u0026Research (JIPMER)","correspondingAuthor":false,"prefix":"","firstName":"Vishnu","middleName":"Prasad N","lastName":"R","suffix":""},{"id":511574701,"identity":"6d7d85d2-37be-4b0b-8eef-81b34b646397","order_by":3,"name":"Avinash S R","email":"","orcid":"","institution":"Jawaharlal Institute of Postgraduate Medical Education \u0026Research (JIPMER)","correspondingAuthor":false,"prefix":"","firstName":"Avinash","middleName":"S","lastName":"R","suffix":""},{"id":511574702,"identity":"bcfa24c7-bdeb-4b80-a84d-731e8bd36696","order_by":4,"name":"Rajeshwari M","email":"","orcid":"","institution":"All India Institute of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Rajeshwari","middleName":"","lastName":"M","suffix":""},{"id":511574703,"identity":"ac90b352-80b4-4be5-8b9a-243bb9f6fcac","order_by":5,"name":"Ankit Jain","email":"","orcid":"","institution":"Jawaharlal Institute of Postgraduate Medical Education \u0026Research (JIPMER)","correspondingAuthor":false,"prefix":"","firstName":"Ankit","middleName":"","lastName":"Jain","suffix":""},{"id":511574704,"identity":"02d60c2c-dd52-4324-8841-04047165da9b","order_by":6,"name":"Gunaseelan K","email":"","orcid":"","institution":"Jawaharlal Institute of Postgraduate Medical Education \u0026Research (JIPMER)","correspondingAuthor":false,"prefix":"","firstName":"Gunaseelan","middleName":"","lastName":"K","suffix":""},{"id":511574705,"identity":"190530c7-9c27-4a02-b1f7-2354c20ed9e7","order_by":7,"name":"Smita Kayal","email":"","orcid":"","institution":"Jawaharlal Institute of Postgraduate Medical Education \u0026Research (JIPMER)","correspondingAuthor":false,"prefix":"","firstName":"Smita","middleName":"","lastName":"Kayal","suffix":""}],"badges":[],"createdAt":"2025-09-04 08:53:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7534081/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7534081/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s12029-025-01363-0","type":"published","date":"2026-01-06T15:57:35+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":91204712,"identity":"db16c7c8-29a6-4318-a73f-179e5129c461","added_by":"auto","created_at":"2025-09-12 16:22:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":113549,"visible":true,"origin":"","legend":"\u003cp\u003eStudy Flowchart illustrating patient selection and propensity score matching comparison between Emergency Colorectal Resection Surgery and Elective Colorectal Resection Surgery in colorectal cancer patients\u003c/p\u003e\n\u003cp\u003eCRC: colorectal cancer, EMCRCS: emergency colorectal surgeries, ELCRS: elective colorectal surgeries\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7534081/v1/6cfb155260db15f31b56b540.png"},{"id":91204028,"identity":"9870ec26-f088-4599-a2e5-ca830d049eb0","added_by":"auto","created_at":"2025-09-12 16:14:30","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":230000,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier curves comparing disease-free survival between elective colorectal resection surgery and emergency colorectal resection surgery groups, both before and after propensity score matching\u003c/p\u003e\n\u003cp\u003eEMCRCS: emergency colorectal surgeries, ELCRS: elective colorectal surgeries\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7534081/v1/51dc10b73b9cfb2683cb22fc.jpeg"},{"id":91204716,"identity":"215cb052-1894-49d3-87b4-ea30966a3251","added_by":"auto","created_at":"2025-09-12 16:22:30","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":156096,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier curves comparing overall survival between elective colorectal resection surgery and emergency colorectal resection surgery groups, both before and after propensity score matching\u003c/p\u003e\n\u003cp\u003eEMCRCS: emergency colorectal surgeries, ELCRS: elective colorectal surgeries\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7534081/v1/602be5ad34c1614f20d8f890.png"},{"id":100069215,"identity":"53cba69e-71b3-42e9-9f6e-703c0c93b08f","added_by":"auto","created_at":"2026-01-12 16:11:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1297489,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7534081/v1/e21e024e-4966-472b-9551-e08a18f83e5b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparative Outcomes of Colorectal Cancer Patients Undergoing Elective and Emergency Surgeries: A Propensity Score Matched Cohort Study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eColorectal cancers (CRC) are the third most diagnosed malignancy and the second leading cause of cancer-related mortality worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Its global incidence continues to rise, particularly in developing nations, driven by economic growth, westernized lifestyles, and dietary habits marked by increased intake of red meat, fats, and total caloric consumption [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. These lifestyle shifts, coupled with increased life expectancy and population growth, are contributing to a growing global burden of CRC.\u003c/p\u003e\u003cp\u003eEarly-stage CRC often remains asymptomatic or presents with vague, non-specific symptoms. Consequently, many patients seek medical care only when the disease has progressed to an advanced stage [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. As a result, approximately 10\u0026ndash;30% of CRC cases are diagnosed during emergency presentations, typically involving complications such as intestinal obstruction, perforation, or gastrointestinal bleeding.⁵ for many of these patients, the initial diagnosis, staging, and assessment of resectability occur perioperatively during emergency surgical intervention.\u003c/p\u003e\u003cp\u003eEmergency colorectal surgeries (EMCRS) have traditionally been associated with worse short-term outcomes compared to elective colorectal surgeries (ELCRS), with reported postoperative morbidity and mortality rates ranging from 15\u0026ndash;50% and 6\u0026ndash;15%, respectively\u0026mdash;substantially higher than the 4\u0026ndash;14% and 1\u0026ndash;7% rates observed with ELCRS [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Additionally, EMCRS is often linked to poorer long-term oncological outcomes, including decreased disease-free survival (DFS) and overall survival (OS). However, other studies have reported no significant differences between the two approaches [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThese inconsistencies may stem from methodological limitations in earlier studies, many of which are observational and include a small proportion of patients undergoing EMCRS. This discrepancy introduces potential confounding biases. While randomized controlled trials would be ideal to minimize such bias, randomizing patients to emergency versus elective surgery is not feasible. In such scenarios, propensity score matching (PSM) offers a robust statistical approach to reduce confounding and simulate randomized comparisons in observational data [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study aims to evaluate the clinicopathological features, perioperative outcomes, and long-term oncological results of EMCRS versus ELCRS using a PSM cohort.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThis study was conducted in the Department of Surgery at a tertiary care center in Southern India. It comprised a combined retrospective and prospective cohort design, covering the period from January 2010 to June 2022. The retrospective arm spanned from January 2010 to April 2021, while the prospective arm extended from April 2021 to June 2022. The study was approved by the Institutional Ethics Committee (IEC) of our institute (JIP/IEC/2021/017). A waiver of consent was granted for retrospectively included participants. The study is also registered with the Clinical Trials Registry \u0026ndash; India (CTRI/2021/11/038084) and adhered to the principles of the Declaration of Helsinki.\u003c/p\u003e\u003cp\u003eThe primary objective of this study was to compare early postoperative morbidity in patients undergoing surgical treatment for CRC in emergency versus elective settings. The secondary objectives included a comparison of histopathological findings of the resected specimens, and inpatient postoperative mortality between the two groups. Additionally, the study aimed to identify the long-term outcomes, including DFS and OS, and were also evaluated to assess the oncological impact of emergency versus elective surgical intervention.\u003c/p\u003e\u003cp\u003eAll patients from age\u0026thinsp;\u0026gt;\u0026thinsp;18 years with CRC who underwent surgery in the department of surgery at our institution during the study period were assessed. Those patients in whom resection of the tumour were done with curative intent during the study period were included in the study. Patients treated with palliative intent, such as internal bypass or proximal stoma formation, patients with metastatic disease, gross residual tumour after resection (R2 resection), adenoma or carcinoma in situ in the post operative pathology, patients whose records cannot be retrieved and patients refusing consent in the prospective period were excluded from the study.\u003c/p\u003e\u003cp\u003eOur study includes two groups of people undergoing CRC surgery. EMCRS group, which included patients presenting with obstruction, perforation, or bleeding requiring immediate resection, and ELCRS group, consisting of patients undergoing scheduled resection after thorough preoperative evaluation.\u003c/p\u003e\u003cp\u003ePerforation was defined as the presence of diffuse or localized peritonitis and/or pneumoperitoneum or localized leak on preoperative radiographs or Computed tomography (CT) scans. Tumors causing obstruction, whether partial or complete, were diagnosed by radiograph or CT and considered as obstructive tumors. Bleeding tumors were identified as those causing severe anemia and hemodynamic instability, requiring emergency resection.\u003c/p\u003e\u003cp\u003eData from the retrospective period (January 2010 to April 2021) were collected from prospectively maintained databases, such as the hospital\u0026rsquo;s cancer registry, case files, and the hospital information system (HIS). In the prospective period (April 2021 to June 2022), data were collected prospectively, with a minimum follow-up period of 6 months.\u003c/p\u003e\u003cp\u003eComplications in the postoperative period were classified according to the Clavien-Dindo grading system [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], and early postoperative morbidity was defined as complications occurring within 30 days of surgery. Postoperative complications included anastomotic leak, surgical site infection (SSI) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], entero-cutaneous fistula, sepsis [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], prolonged ileus, small bowel obstruction, chest infection, cardiac complications, and deep vein thrombosis (DVT). The total Length of hospital stay was calculated from the day of admission to discharge/death, and the length of postoperative hospital stay was calculated from \u0026ldquo;the day of surgery to discharge/death.\u0026rdquo; Inpatient mortality includes the death of a patient that has occurred in the hospital, during the hospital stay of index surgery. Histopathological tumour characters in both groups were compared based on the location, lymphovascular invasion, perineural invasion, circumferential resected margin, lymph node yield, grade, and tumour staging done according to the American joint committee on cancer (AJCC) tumour, node, and metastasis (TNM) classification [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. DFS was defined as the time from surgical resection to cancer recurrence, while OS was defined as the time from surgery to death from any cause. DFS and OS were calculated only for the retrospective period.\u003c/p\u003e\u003cp\u003eDemographic data [age, sex, Body mass index (BMI)], clinical details [American Society of Anesthesiologists (ASA) class, comorbidities, smoking status, neoadjuvant therapy], operative data (tumor location, surgical resection type, blood loss, operative time), and postoperative details (complications, length of hospital stay, death, pathological results) were collected. Follow-up data included adjuvant therapy, development of late complications, disease recurrence, survival, and cause of death.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis:\u003c/h2\u003e\u003cp\u003eStatistical analysis was conducted using IBM SPSS version 19.0. The normality of continuous data was assessed using the Kolmogorov\u0026ndash;Smirnov test. Continuous variables, such as age, duration of symptoms, BMI, and length of hospital stay, were expressed as means with standard deviations or medians with interquartile ranges (IQR), depending on the data distribution. Categorical variables, including sex, clinical presentation, type of surgery, complications (e.g., SSI, anastomotic leak, sepsis, enterocutaneous fistula, chest infection, DVT, pulmonary embolism), and wound category, were summarized as frequencies and percentages.\u003c/p\u003e\u003cp\u003eFor continuous variables, differences between groups were analysed using the independent Student t-test or Mann-Whitney U test, as appropriate. Categorical variables were compared using the chi-square (χ2) test or Fisher exact test. Logistic regression was applied to identify factors associated with inpatient mortality, with covariates showing P-values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in univariate analysis included in the model. A two-sided P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. Kaplan-Meier curves were used for survival analysis, and log-rank tests were used to compare survival between groups. PSM was performed using a 1:1 nearest neighbour matching algorithm, with standard distance determined by logistic regression. PSM was based on variables such as age, gender, tumor location, and tumour stage.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 558 patients who underwent surgery for CRC were initially assessed. After applying exclusion criteria 106 EMCRS and 305 ELCRS cases remained. PSM was performed based on age, sex, tumor location, and stage, resulting in 106 matched pairs. These matched cohorts were analyzed for early post-operative complications (n=106 per group) and survival outcomes (n=88 per group) (Fig. 1).\u003c/p\u003e\n\u003cp\u003eComparison of patient characteristics showed no significant differences in age, gender, BMI, or comorbidities, but EMCRS patients had more proximal tumors, higher rates of poorly differentiated tumors, and more advanced disease stages (Table 1).\u003c/p\u003e\n\u003cp\u003eTable-1: Baseline patient and histopathological characteristics of elective and emergency colorectal cancer surgery groups.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"576\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eELCRS (n=305)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEMCRS (n=106)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003csup\u003e\u0026nbsp;\u003c/sup\u003e(Years)\u003csup\u003e$\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e58 (46, 65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e55 (47, 65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e0.76\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 576px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e171 (56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e59 (55.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 128px;\"\u003e\n \u003cp\u003e0.94\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e134 (44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e47 (44.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI\u003csup\u003e\u0026nbsp;\u003c/sup\u003e(Kg/m\u003csup\u003e2\u003c/sup\u003e)\u003csup\u003e\u0026nbsp;$\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e19.8 (18.6, 20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e19.9 (17.8, 20.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e0.458\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 576px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eDiabetes Meletus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e56 (18.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e20 (18.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e0.90\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e64 (21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e21 (19.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e0.797\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eCoronary artery disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e17 (5.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e5 (4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e0.736\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eChronic liver disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e2 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e0.165\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eChronic kidney disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e6 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e2 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e1.000\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 576px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTumour location\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eCaecum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e32 (10.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e30 (28.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"7\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eAscending colon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e29 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e13 (12.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eTransverse colon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e30 (9.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e21 (19.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eDescending colon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e18 (5.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e14 (13.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eSigmoid colon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e48 (15.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e18 (17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eRectosigmoid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e71 (23.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e8 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eRectum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e77 (25.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e2 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 576px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistological characters \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eWell differentiated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e245 (80.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e88 (83%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eModerately differentiated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e56 (18.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e10 (9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003ePoorly differentiated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e4 (1.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e8 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003ePositive Circumferential resected margin;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e27 (9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e17 (16.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eLymphovascular invasion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e124 (40.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e57 (55.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.009\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003ePerineural invasion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e44 (14.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e19 (19.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e0.260\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 576px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e64 (21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e15 (14.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"7\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003csup\u003e#\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eIIA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e98 (32.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e22 (20.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eIIB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e10 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e7 (6.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eIIC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e1 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eIIIA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e12 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e1 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eIIIB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e98 (32.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e43 (40.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eIIIC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e23 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e17 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian lymph node harvest\u003csup\u003e$\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e14 (10, 28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e13 (10, 21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e0.812\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 576px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAmerican Society of Anesthesiologists (ASA) class\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e60 (19.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e18 (17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e186 (61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e44 (41.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e58 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e34 (32.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e10 (9.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e$-Continuous variables expressed as median (interquartile range).\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e*\u003c/sup\u003ePearson Chi-square test; \u0026nbsp;\u003csup\u003e#\u003c/sup\u003eFisher\u0026rsquo;s Exact test;\u003c/p\u003e\n\u003cp\u003eBMI- Body mass index, ELCRS \u0026ndash; Elective colorectal surgeries; EMCRS \u0026ndash; Emergency colorectal surgeries\u003c/p\u003e\n\u003cp\u003ePostoperative complications were significantly higher in EMCRS, including SSIs (56.6% vs. 38.7%), sepsis (16% vs. 3.9%), and pulmonary complications (25.5% vs. 6.9%) before PSM. After PSM, differences in SSIs and anastomotic leaks were no longer significant, but EMCRS patients continued to experience higher rates of sepsis, pulmonary, and cardiac complications. Severe complications (Clavien-Dindo Grades IV and V) and inpatient mortality were markedly higher in EMCRS, with mortality rates remaining significantly elevated both before (17.9% vs. 2.3%) and after PSM (17.9% vs. 0.9%) (Table 2).\u003c/p\u003e\n\u003cp\u003eTable 2. Comparison of early postoperative outcomes between elective and emergency colorectal cancer surgery groups before and after Propensity Score Matching.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithout PSM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWith PSM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eELCRS (n = 305)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eEMCRS (n = 106)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003ep- value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003eELCRS (n = 106)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eEMCRS (n = 106)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003ep- value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 624px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePOSTOPERATIVE COMPLICATIONS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eSurgical site infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e118 (38.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e60 (56.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e49 (46.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e60 (56.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.131\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eAnastomotic leak\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e13 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e10 (9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.046\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e4 (3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e10 (9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.097\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eEnterocutaneous fistula\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e1 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.258\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e1 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.316\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eSepsis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e12 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e17 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e3(2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e17 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003ePulmonary complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e21 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e27 (25.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e8(7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e27 (25.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eCardiac complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e4 (1.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e17 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e2 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e17 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eDeep vein thrombosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e2 (0.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e1 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e1.000\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e1 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e1.000\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003ePost operative morbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e124 (40.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e75 (71.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e51 (48.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e75 (71.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eIntensive care unit admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e35 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e46 (43.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e3 (2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e46 (43.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 624px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCLAVIEN-DINDO CLASSIFICATION\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e101 (33.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e37 (34.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"7\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e44(41.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e37 (34.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"7\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e8 (2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e13 (12.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e14 (13.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eIIIa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e7 (2.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e1 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e4 (3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e1 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eIIIb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e2 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e2 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eIva\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e1 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e3 (2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e3 (2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eIVb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e1 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e1 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1(0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e4 (3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e7 (2.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e19 (17.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e15 (14.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eInpatient mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e7 (2.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e19 (17.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e19 (17.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003e*\u003c/sup\u003ePearson Chi-square; \u003csup\u003e#\u003c/sup\u003eFisher\u0026rsquo;s Exact test;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eELCRS - Elective colorectal surgeries; EMCRS - Emergency colorectal surgeries; PSM - Propensity Score Matching.\u003c/p\u003e\n\u003cp\u003eIn terms of survival, before PSM, ELCRS patients had significantly better DFS and OS compared to EMCRS patients (DFS: 73 \u0026plusmn; 3 vs. 46 \u0026plusmn; 5 months; OS: 89 \u0026plusmn; 3 vs. 57 \u0026plusmn; 5 months, both p\u0026lt;0.001). However, after PSM, the differences in DFS and OS were not statistically significant (DFS: 58\u0026plusmn;3 vs. 46\u0026plusmn;5 months, p=0.19; OS: 67.5\u0026plusmn;2.9 vs. 57\u0026plusmn;5 months, p=0.391) (Table 3, Fig. 2 and 3).\u003c/p\u003e\n\u003cp\u003eTable 3. Comparison of oncological outcomes between elective and emergency colorectal cancer surgery groups before and after Propensity Score Matching.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 244px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithout PSM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 244px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWith PSM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eELCRS (n =259)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEMCRS (n = 88)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eELCRS (n = 88)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEMCRS (n = 88)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean Disease free survival\u003csup\u003e\u0026alpha;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(months)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e73 \u0026plusmn; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e46 \u0026plusmn; 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003csup\u003e\u0026amp;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e58 \u0026plusmn; 3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e46 \u0026plusmn; 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.19\u003csup\u003e\u0026amp;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean Overall survival \u003csup\u003e\u0026alpha;\u003c/sup\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(months)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e89 \u0026plusmn; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e57 \u0026plusmn; 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003csup\u003e\u0026amp;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e67.5 \u0026plusmn; 2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e57 \u0026plusmn; 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.391\u003csup\u003e\u0026amp;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003e*\u003c/sup\u003ePearson Chi-square test; \u003csup\u003e\u0026amp;\u0026nbsp;\u003c/sup\u003eLog Rank test, \u003csup\u003e\u0026alpha;-\u0026nbsp;\u003c/sup\u003emean\u0026plusmn; SE;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eELCRS \u0026ndash; Elective colorectal surgeries; EMCRS \u0026ndash; Emergency colorectal surgeries; PSM - Propensity Score\u0026nbsp;\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe short-term surgical outcomes and long-term oncological outcomes in patients undergoing emergency versus elective surgery for CRC remain a topic of ongoing debate. While multiple studies have reported unfavorable outcomes following emergency surgery, various confounding factors\u0026mdash;such as compromised oncological technique, limited preoperative assessment, and patient frailty\u0026mdash;have been proposed to explain the observed differences in long-term survival [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In our cohort study, we assessed both short-term and long-term oncological outcomes in patients with CRC who underwent surgery with curative intent in the emergency and elective settings. Notably, postoperative morbidity and mortality were significantly higher in the EMCRS group compared to the ELCRS group, and these differences remained significant even after PSM. Interestingly, although patients in the EMCRS group had poorer DFS and OS in the unmatched cohort, these differences were not statistically significant after matching.\u003c/p\u003e\u003cp\u003eIn our study, the most frequent tumor site in the EMCRS group was the right colon, whereas rectal or rectosigmoid tumors were more common in the ELCRS group. This distribution may be attributed to the fact that left-sided tumors tend to produce earlier symptoms, such as altered bowel habits or rectal bleeding, prompting elective evaluation and intervention. In contrast, right-sided tumors often present later due to more insidious symptoms. Another contributing factor could be the need for neoadjuvant therapy in rectal cancers. In emergency settings, surgeons may prefer diversion procedures over definitive resections for rectal tumors, resulting in different management strategies between the two groups. These variations could also reflect regional practice differences, as previous studies have reported inconsistent tumor distributions in emergency settings [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Additionally, right-sided colon cancers are frequently diagnosed at more advanced stages. A larger tumor burden increases the risk of complications such as obstruction, bleeding, and perforation, common indications for emergency surgery, thereby contributing to the higher rate of emergent presentations [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe EMCRS group in our study had significantly higher in-hospital morbidity and mortality, and these differences persisted even after PSM. This aligns with several previous studies attributing poorer outcomes in emergency surgeries to acute and/or severe physiological derangements at presentation [\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The ASA class, a surrogate marker for physiological status, was significantly higher in the EMCRS group in our cohort, consistent with literature [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Other Contributing factors include malnutrition, reduced physiological reserve, and the lack of opportunity for prehabilitation in emergency settings. To improve short-term outcomes in this frail patient population, an interdisciplinary approach involving emergency physicians, surgeons, anesthesiologists, nutritionists, and intensivists is essential [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe impact of EMCRS on long-term oncological outcomes remains controversial. Several studies have reported poorer long-term survival in patients undergoing emergency surgery. These outcomes have been attributed to tumor- and patient-related factors such as advanced stage at presentation, inadequate lymph node yield, aggressive tumor biology, incomplete resections, occult metastases, and elevated inflammatory markers like C-reactive protein [\u003cspan additionalcitationids=\"CR24 CR25\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn our study, although crude DFS and OS were lower in the EMCRS group, these differences were not statistically significant after PSM, indicating comparable long-term outcomes between EMCRS and ELCRS. Similar findings have been reported in other studies that used matched cohorts to compare outcomes among patients with similar baseline characteristics (e.g., age, gender, tumor location, and stage) [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Another important consideration is adherence to oncological surgical principles during emergency surgeries. Lymph node yield, a surrogate marker for surgical quality and staging accuracy, has shown considerable variation in prior studies, being reported as lower [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], equal [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], or even higher [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] in EMCRS compared to ELCRS. In our study, lymph node harvest was comparable between the two groups, suggesting that oncological standards were maintained even in emergency settings. This, coupled with the use of PSM to ensure comparability of baseline characteristics, the long-term oncological outcomes may not be compromised. Furthermore, our findings support the notion that tumors presenting emergently may share similar biological characteristics with those treated electively, contradicting earlier assumptions that emergency presentations are associated with inherently more aggressive tumor biology [\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGiven the higher perioperative risks and advanced presentations associated with EMCRS, enhancing surveillance in high-risk individuals and implementing population-level screening programs is crucial. Early detection through screening can facilitate timely diagnosis and elective surgical planning, ultimately improving outcomes. The profile of CRCs presenting emergently in our cohort also underscores the need for broader awareness and preventive strategies, which may differ from patterns reported in other regions.\u003c/p\u003e\u003cp\u003eThis study has several limitations. First, the retrospective nature of most of the study period limited access to complete data on adjuvant and neoadjuvant therapies, potentially introducing confounding factors that could influence long-term outcomes. Second, being a single-center study, the generalizability of our findings to other institutions or broader populations may be limited. Third, we did not perform subgroup analyses based on tumor location (colon vs. rectum), which may have provided more detailed insights into site-specific variations in presentation and outcomes. Lastly, the mode of surgery whether open, laparoscopic, or robotic was not accounted for, and this could have impacted both perioperative and oncological outcomes.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eEMCRCS carries a higher risk of short-term morbidity and mortality compared with elective surgery, largely due to advanced disease and limited preoperative optimization. However, when baseline characteristics are balanced and oncological principles are maintained, long-term outcomes are comparable between the two groups. These findings emphasize the importance of early detection, standardized surgical care, and multidisciplinary management to improve outcomes in patients presenting emergently.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThe authors did not receive support from any organization for conducting the study or preparing the manuscript or the submitted work\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest/competing interests:\u003c/strong\u003e All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval:\u0026nbsp;\u003c/strong\u003eThe study was approved by the institute Ethical committee\u003cstrong\u003e\u0026nbsp;(\u003c/strong\u003eJIP/IEC/2021/017).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contribution statements.\u0026nbsp;\u003c/strong\u003eAll authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by [Kedareswar], [Reddy Abhinaya P], and [Avinash S R]. The first draft of the manuscript was written by [Reddy Abhinaya P] and [Avinash S R], and all authors commented on previous versions of the manuscript. All authors read and approved of the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability:\u0026nbsp;\u003c/strong\u003eThe datasets generated and/or analyzed during the current study will be made available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support for this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMorgan E, Arnold M, Gini A, Lorenzoni V, Cabasag CJ, Laversanne M, et al (2023). Global burden of colorectal cancer in 2020 and 2040: incidence and mortality estimate from GLOBOCAN. Gut 72:338-344. https://doi.org/10.1136/gutjnl-2022-327736\u003c/li\u003e\n\u003cli\u003eBray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al (2024). Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 74:229-263. https://doi.org/10.3322/caac.21834\u003c/li\u003e\n\u003cli\u003eBishehsari F, Mahdavinia M, Vacca M, Malekzadeh R, Mariani-Costantini R (2014). Epidemiological transition of colorectal cancer in developing countries: environmental factors, molecular pathways, and opportunities for prevention. World J Gastroenterol 20:6055-6072. https://doi.org/10.3748/wjg.v20.i20.6055\u003c/li\u003e\n\u003cli\u003eSaraiva MR, Rosa I, Claro I (2023). Early-onset colorectal cancer: A review of current knowledge. World J Gastroenterol 29:1289. https://doi.org 10.3748/wjg.v29.i8.1289\u003c/li\u003e\n\u003cli\u003eCosta G, Frezza B, Fransvea P, Massa G, Ferri M, Mercantini P, et al (2019). 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Ann Surg 240:205-213. https://doi.org/10.1097/01.sla.0000133083.54934.ae\u003c/li\u003e\n\u003cli\u003eBerr\u0026iacute;os-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al (2017). Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 152:784-791. https://doi.org/10.1001/jamasurg.2017.0904\u003c/li\u003e\n\u003cli\u003eDellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al (2013). Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 41:580-637. https://doi.org/10.1097/CCM.0b013e31827e83af\u003c/li\u003e\n\u003cli\u003eHari DM, Leung AM, Lee JH, Sim MS, Vuong B, Chiu CG, et al (2013). AJCC Cancer Staging Manual 7th edition criteria for colon cancer: do the complex modifications improve prognostic assessment? J Am Coll Surg 217:181-190. https://doi.org/10.1016/j.jamcollsurg.2013.04.018\u003c/li\u003e\n\u003cli\u003eWeiser MR. AJCC (2018) 8th Edition: colorectal cancer. Ann Surg Oncol 25:1454-1455.2019;34(12):2091-9. https://doi.org/10.1245/s10434-018-6462-1 \u003c/li\u003e\n\u003cli\u003eXu Z, Becerra AZ, Aquina CT, Hensley BJ, Justiniano CF, Boodry C, Swanger AA, Arsalanizadeh R, Noyes K, Monson JR, Fleming FJ (2017). Emergent colectomy is independently associated with decreased long-term overall survival in colon cancer patients. J Gastrointest Surg. 21:543-553. https://doi.org/10.1007/s11605-017-3355-8\u003c/li\u003e\n\u003cli\u003eLavanchy JL, Vaisnora L, Haltmeier T, Zlobec I, Br\u0026uuml;gger LE, Candinas D, et al (2019). Oncologic long-term outcomes of emergency versus elective resection for colorectal cancer. Int J Colorectal Dis 34:2091-2099. https://doi.org/10.1007/s00384-019-03426-8\u003c/li\u003e\n\u003cli\u003eWanis KN, Ott M, Van Koughnett JAM, Colquhoun P, Brackstone M (2018). Long-term oncological outcomes following emergency resection of colon cancer. Int J Colorectal Dis 33:1525-1532. https://doi.org/10.1007/s00384-018-3109-4\u003c/li\u003e\n\u003cli\u003eGhazi S, Berg E, Lindblom A, Lindforss U, Low-Risk Colorectal Cancer Study Group (2013) Clinicopathological analysis of colorectal cancer: a comparison between emergency and elective surgical cases. World J Surg Oncol 11:133. https://doi.org/10.1186/1477-7819-11-133\u003c/li\u003e\n\u003cli\u003eAhmadinejad M, Pouryaghobi SM, Bayat F, Bolvardi E, Chokan NM, Masoumi B, Ahmadi K (2018). Surgical outcome and clinicopathological characteristics of emergency presentation elective cases of colorectal cancer. 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Comparison of short-term surgical outcomes and long-term survival between emergency and elective surgery for colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 38:41. https://doi.org/10.1007/s00384-023-04334-8\u003c/li\u003e\n\u003cli\u003eFinlay, I. G., \u0026amp; McArdle, C. S. (1986). Occult hepatic metastases in colorectal carcinoma. Br J Surg 73:732\u0026ndash;735. https://doi.org/10.1002/bjs.1800730918\u003c/li\u003e\n\u003cli\u003eKinoshita, T., Ito, H., \u0026amp; Miki, C. (1999). Serum interleukin-6 level reflects the tumor proliferative activity in patients with colorectal carcinoma. Cancer 85:2526\u0026ndash;2531. https://doi.org/10.1002/(sici)1097-0142(19990615)85:12\u0026lt;2526::aid-cncr6\u0026gt;3.0.co;2-3\u003c/li\u003e\n\u003cli\u003eAntony P, Harnoss JC, Warschkow R, Schmied BM, Schneider M, Tarantino I, Ulrich A (2019) Urgent surgery in colon cancer has no impact on survival. J Surg Oncol 119:1170-1178. https://doi.org/10.1002/jso.25469.\u003c/li\u003e\n\u003cli\u003eBiondo S, Mart\u0026iacute;-Ragu\u0026eacute; J, Kreisler E, Par\u0026eacute;s D, Mart\u0026iacute;n A, Navarro M, Pareja L, Jaurrieta E (2005) A prospective study of outcomes of emergency and elective surgeries for complicated colonic cancer. Am J Surg 189:377-383. https://doi.org/10.1016/j.amjsurg.2005.01.009. \u003c/li\u003e\n\u003cli\u003eWanis, K. N., Ott, M., Van Koughnett, J. A. M., Colquhoun, P., \u0026amp; Brackstone, M. (2018) Long-term oncological outcomes following emergency resection of colon cancer. Int J Colorectal Dis 33:1525\u0026ndash;1532. https://doi.org/10.1007/s00384-018-3109-4\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-gastrointestinal-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijgc","sideBox":"Learn more about [Journal of Gastrointestinal Cancer](https://www.springer.com/journal/12029)","snPcode":"12029","submissionUrl":"https://submission.nature.com/new-submission/12029/3","title":"Journal of Gastrointestinal Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Colon cancer, Colorectal surgery, Emergency colorectal surgery, Propensity score matching, Postoperative outcomes","lastPublishedDoi":"10.21203/rs.3.rs-7534081/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7534081/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003cbr\u003e\nColorectal 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).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003cbr\u003e\nThis 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).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003cbr\u003e\nAmong 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).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003cbr\u003e\nEMCRS 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\u003c/p\u003e","manuscriptTitle":"Comparative Outcomes of Colorectal Cancer Patients Undergoing Elective and Emergency Surgeries: A Propensity Score Matched Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-12 16:14:26","doi":"10.21203/rs.3.rs-7534081/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-13T00:36:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-07T18:50:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-14T13:52:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"184985915184966405503775889373226929718","date":"2025-09-14T01:23:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"88620518161665704963457856450462454590","date":"2025-09-13T21:40:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"106424010172517699643725876572884144834","date":"2025-09-08T02:36:10+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-07T23:52:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-07T23:51:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-05T01:28:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Gastrointestinal Cancer","date":"2025-09-04T08:39:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-gastrointestinal-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijgc","sideBox":"Learn more about [Journal of Gastrointestinal Cancer](https://www.springer.com/journal/12029)","snPcode":"12029","submissionUrl":"https://submission.nature.com/new-submission/12029/3","title":"Journal of Gastrointestinal Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"b0e24b7f-600a-43c2-90fc-ec8026ace55c","owner":[],"postedDate":"September 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-12T16:01:45+00:00","versionOfRecord":{"articleIdentity":"rs-7534081","link":"https://doi.org/10.1007/s12029-025-01363-0","journal":{"identity":"journal-of-gastrointestinal-cancer","isVorOnly":false,"title":"Journal of Gastrointestinal Cancer"},"publishedOn":"2026-01-06 15:57:35","publishedOnDateReadable":"January 6th, 2026"},"versionCreatedAt":"2025-09-12 16:14:26","video":"","vorDoi":"10.1007/s12029-025-01363-0","vorDoiUrl":"https://doi.org/10.1007/s12029-025-01363-0","workflowStages":[]},"version":"v1","identity":"rs-7534081","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7534081","identity":"rs-7534081","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}