{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:36:47Z","timestamp":1787027807287,"version":"build-2736575974"},"reference-count":35,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Emergency surgery for complicated colorectal cancer (CRC) presenting with obstruction, perforation, or uncontrolled bleeding has high postoperative mortality, especially in older patients. However, age-related risk and the roles of radical versus palliative treatment are not fully understood. This study aimed to measure 90-day and 36-month mortality after emergency CRC surgery and to analyze whether the relationship between age and mortality is nonlinear and influenced by operative intent. Methods: Retrospective cohort of consecutive adults undergoing emergency surgery for complicated CRC (2015\u20132024). The outcome was 90-day and 36-month all-cause mortality. Cox regression provided adjusted hazard ratios (HR) using two models: a primary whole-cohort model omitting pathological T\/N stage, and a secondary resection-only model including pathological stage. Age was modeled with restricted cubic splines and predicted 90-day and 36-month mortality were plotted by operative intent. Results: In 496 patients, 90-day mortality was 19.7% (98\/496), while 36-month mortality was 37.3% (185\/496). In the primary whole-cohort Cox model, independent predictors of 36-month mortality included age \u226575 years (HR 2.09, 95% CI 1.48\u20132.95, p &lt; 0.001), Charlson Comorbidity Index (HR 1.02, 95% CI 0.98\u20131.06, p = 0.31), obstruction (HR 1.69, 95% CI 1.18\u20132.42, p = 0.004), perforation (HR 2.05, 95% CI 1.24\u20133.39, p = 0.005), and metastatic disease (HR 2.30, 95% CI 1.62\u20133.27, p &lt; 0.001); radical operative intent was independently associated with lower 36-month mortality (HR 0.461, 95% CI 0.30\u20130.71, p = 0.001). In a secondary resection-only model additionally adjusting for pathological T\/N stage (n = 426 with available pathology), the association for radical intent was attenuated and no longer statistically significant (HR 0.67, 95% CI 0.43\u20131.03, p = 0.067). The 36-month mortality spline estimate indicated an increasing risk with advancing age; a likelihood-ratio test did not show that the spline model fit significantly better than a linear age term (\u03c72 = 1.43, df = 1, p = 0.233), so this pattern is interpreted descriptively rather than as formal evidence of nonlinearity, and no formal interaction between age and operative intent was demonstrated. Conclusions: Ninety-day mortality after emergency colon cancer surgery remains significant. Age-related risk shows a predominantly monotonic, descriptive pattern and should not be assumed to vary by operative intent without formal interaction testing, emphasizing individualized risk assessment and shared decision-making.<\/jats:p>","DOI":"10.3390\/cancers18162646","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T10:04:36Z","timestamp":1786961076000},"page":"2646","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Age, Operative Intent, and Mortality After Emergency Colorectal Cancer Surgery: An Exploratory Analysis of Age-Related Patterns"],"prefix":"10.3390","volume":"18","author":[{"given":"Vito","family":"Laterza","sequence":"first","affiliation":[{"name":"Department of Digestive Surgery, Surgical Oncology and Liver Transplantation, University Hospital of Besan\u00e7on, 25000 Besan\u00e7on, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6709-2531","authenticated-orcid":false,"given":"Marcello","family":"Covino","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"},{"name":"Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1136-1103","authenticated-orcid":false,"given":"Carlo Alberto","family":"Schena","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Fondazione Poliambulanza Istituto Ospedaliero, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Della Polla","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3079-5233","authenticated-orcid":false,"given":"Caterina","family":"Cina","sequence":"additional","affiliation":[{"name":"Department of Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filomena","family":"Misuriello","sequence":"additional","affiliation":[{"name":"Department of Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Alfieri","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"},{"name":"Department of Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7280-8354","authenticated-orcid":false,"given":"Fausto","family":"Rosa","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"},{"name":"Department of Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"ref_1","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. 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