Local and National Trends in Emergency Presentation of Colon and Rectal Cancer

Emergent diagnosis of colorectal cancer is associated with increased postoperative complications and poorer prognosis. We assessed the rate of emergent presentation of colorectal cancer at our institution, identified risk factors for emergent presentation, and compared our results to national data.

Retrospective review was conducted of all patients treated for colon and rectal cancer at a single institution between 2012 and 2021. Pearson correlation identified trends over time in four major outcomes: setting of diagnosis, urgent/emergent surgery, obstruction, and/or perforation. Binomial logistic regression determined associations between outcomes and preoperative/demographic factors. NSQIP data of colectomy for colon cancer from 2012 to 2021 was analyzed for equivalent outcomes.

Seven hundred thirty-three patients with colon cancer and 429 with rectal cancer were included. Of patients with colon cancer, 48.2% were diagnosed in the inpatient setting, 31.8% underwent urgent/emergent surgery, 26.0% were obstructed, and 8.9% were perforated. Of patients with rectal cancer, 28.3% were diagnosed in the inpatient setting, 12.2% underwent urgent/emergent surgery, 18.0% were obstructed, and 6.0% were perforated. All outcomes increased over time. NSQIP reports 6.4% of colectomies for colon cancer were emergent, 4.0% of patients were obstructed, and 1.5% of patients were perforated, with no significant change over time. Medicaid insurance increased likelihood of emergent diagnosis and up to date colonoscopy was protective.

The rate of emergent presentation and treatment of colon and rectal cancer at our institution is high compared to national data and is increasing over time. Risk factors identified suggest access to care is a barrier to timely diagnosis and treatment.