Gökdere OG, Kanat BH. Emergency presentation predicts advanced pathological stage in colorectal cancer: An ordinal regression analysis. World J Gastrointest Oncol 2026; 18(7): 120893 [DOI: 10.4251/wjgo.v18.i7.120893]
Corresponding Author of This Article
Osman G Gökdere, MD, Department of General Surgery, Malatya Turgut Özal University, Alacakapı Mahallesi, Battalgazi, Malatya 44090, Türkiye. osman.gokdere@ozal.edu.tr
Research Domain of This Article
Surgery
Article-Type of This Article
research-article
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Jul 15, 2026; 18(7): 120893 Published online Jul 15, 2026. doi: 10.4251/wjgo.v18.i7.120893
Emergency presentation predicts advanced pathological stage in colorectal cancer: An ordinal regression analysis
Osman G Gökdere, Burhan H Kanat
Osman G Gökdere, Burhan H Kanat, Department of General Surgery, Malatya Turgut Özal University, Malatya 44090, Türkiye
Author contributions: Gökdere OG designed the study, interpreted the results, drafted the manuscript, contributed to study design, performed data analysis, and assisted in manuscript writing; Kanat BH contributed to data collection, statistical analysis, manuscript writing, and literature review; and all authors thoroughly reviewed and endorsed the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Malatya Turgut Özal University Non-Interventional Clinical Research, approval No. E-30785963-020-295071.
Informed consent statement: The informed consent was waived by the Institutional Review Board.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Due to patient privacy and ethical restrictions, the underlying raw data are not publicly available in accordance with institutional data protection regulations. However, de-identified data can be made available from the corresponding author upon reasonable request and with permission from Malatya Turgut Özal University institutional authorities.
Corresponding author: Osman G Gökdere, MD, Department of General Surgery, Malatya Turgut Özal University, Alacakapı Mahallesi, Battalgazi, Malatya 44090, Türkiye. osman.gokdere@ozal.edu.tr
Received: March 11, 2026 Revised: March 17, 2026 Accepted: April 16, 2026 Published online: July 15, 2026 Processing time: 119 Days and 10.3 Hours
Abstract
BACKGROUND
Emergency surgery in colorectal cancer (CRC) is traditionally considered a technical and perioperative challenge. However, whether emergency presentation is independently associated with more advanced pathological disease at diagnosis remains unclear.
AIM
To evaluate whether emergency presentation is associated with a more advanced pathological stage in patients undergoing surgical resection for CRC.
METHODS
This retrospective study included patients undergoing surgical resection for colorectal adenocarcinoma between January 2021 and December 2025. Patients were grouped as emergency or elective. Pathological stage was defined according to the tumor-node-metastasis classification and analyzed as an ordinal variable (stage I-IV). Ordinal logistic regression using a proportional odds model was performed to determine whether emergency presentation predicted a higher pathological stage, adjusting for age, sex, American Society of Anesthesiologists physical status, and tumor location (rectal/rectosigmoid vs others).
RESULTS
Among the 152 patients, 56 (36.8%) underwent emergency surgery and 96 (63.2%) elective surgery. Emergency presentation was significantly associated with higher pathological stage (P < 0.001). Stage IV disease was more frequent in the emergency surgery group (46.4% vs 10.4%), and 80.4% of patients in the emergency surgery group had advanced disease (stage III-IV) compared with 46.9% of elective patients (odds ratio: 4.64, 95% confidence interval: 2.14-10.03; P < 0.001). Emergency presentation remained an independent predictor of higher pathological stage (adjusted odds ratio: 5.27, 95% confidence interval: 2.60-10.70; P < 0.001). Emergency surgery was also associated with increased postoperative and major complications, intensive care unit admission, and longer hospital stay, indicating worse overall outcomes and increased healthcare burden.
CONCLUSION
Emergency presentation in CRC is strongly associated with more advanced pathological disease at diagnosis. This stage-shifting effect may partly explain the poorer short-term outcomes observed in emergency colorectal surgery and highlights the importance of early detection and timely intervention.
Core Tip: Emergency presentation in colorectal cancer is commonly associated with poorer surgical outcomes; however, its relationship with pathological disease stage has not been fully clarified. In this retrospective study, pathological stage was analyzed as an ordinal outcome to preserve the biological continuum of tumor progression. Emergency presentation was strongly associated with a higher pathological stage and remained an independent predictor of advanced disease after adjustment for clinical covariates. These findings suggest that emergency presentation reflects a substantial oncological disease burden rather than merely surgical urgency, providing important context for the poorer short-term outcomes observed in emergency colorectal surgery.
