Urgent Colectomies for Cancer: Evaluating the Role of Specialized Colorectal Surgeons.

Background Urgent colectomies constitute a significant portion of acute care surgery (ACS). While general surgeons (GS) typically perform colonic resections, more complex cases, particularly those involving colorectal cancer (CRC) and inflammatory bowel disease, may demand a higher level of expertise. This study examines the outcomes of CRC-related urgent colectomies with end stoma performed by colorectal specialist (CRS) surgeons compared to those conducted by GS without sub-specialization or with sub-specialization other than CRS. Methods This study analyzed data from patients who underwent emergent colectomy with end stoma due to complications related to colon cancer at a single tertiary hospital between 2013 and 2023. Patients were grouped according to the presence of a CRS surgeon in the surgery. The primary outcomes measured were 90-day perioperative complications, including mortality. Secondary outcomes included quality metrics of the resected specimen as well as oncological outcomes.  Results The study included 98 patients undergoing emergent colon resection with end stoma, with a mean age of 70.05 ± 14.6 years and a gender distribution of 60 females to 38 males. The mean Charlson comorbidity score was 4.01 ± 2.6. Colorectal surgeons were present in the operations of 32 patients (32.7%). No significant differences were found in baseline characteristics between the groups. The 90-day complication rate was similar between the CRS and GS groups (40.6% vs. 36.9%, p=0.724), as was the rate of major complications (Clavien-Dindo (CD) ≥3, 12.5% vs. 19.7%, p=0.378). The 90-day mortality rate was lower in the CRS group (6.45% vs. 15.1%), but this difference was not statistically significant (p=0.327). The number of lymph nodes (LN) in the specimen was significantly higher in the CRS group (24.6 ± 13.4 vs. 19.1 ± 8.8, p=0.019); however, inadequate lymphadenectomy rate (defined as fewer than 12 LN) did not differ between the groups (16.7% GS vs. 15.6% CRS, p=0.991). Positive margins were rare, with all occurrences found in the GS group (four radial, one distal, 7.6% vs. 0%, p=0.11). Kaplan-Meier survival curves indicated no significant difference in overall survival (log-rank p=0.236) over a median follow-up of 1.5±2.67 years, though the CRS group's curve was consistently higher than that of the GS group. Conclusion Urgent colectomies related to colon cancer show comparable outcomes when performed by GS and CRS, with the exception of a higher lymphadenectomy yield in the CRS group. Given the limitations of the study's small sample size and retrospective design, which may result in underpowering, there is a potential trend toward improved survival and reduced major complication rates for the CRS group that did not reach statistical significance. Future research should investigate this issue in a larger, prospective study.