Colorectal cancer in the emergency setting: new international recommendations led by SAGES

05/29/2026 · Dr. Patricia Tejedor

Colorectal cancer in the emergency setting · SAGES recommendations · Dr. Patricia Tejedor

Dr. Patricia Tejedor, colorectal surgeon at Quenet-Torrent Institute, is the first author of the article "Clinical spotlight review: best practices for the management of colorectal cancer in the emergency and acute care setting", published in the scientific journal Surgical Endoscopy.

An international scientific collaboration

The work is part of an initiative of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), carried out through its Colorectal Surgery and Emergency Surgery committees.

An international group of surgeons takes part in the project, with the aim of setting out practical recommendations for the management of colorectal cancer that presents as an emergency, especially in cases of bowel obstruction, perforation or bleeding.

Why colorectal cancer in the emergency setting is a clinical challenge

These emergency presentations are a significant clinical challenge. They are usually associated with:

Tumors at a more advanced stage at the time of diagnosis.
Greater surgical complexity and the need for emergency surgery.
A higher risk of postoperative complications.
Worse oncological outcomes in the medium and long term compared with elective surgery.

For this reason, the article reviews the available scientific evidence and proposes management strategies aimed at improving decision-making in highly complex scenarios.

Main recommendations for surgical management

Among its most relevant conclusions, the work highlights the importance of:

Making a fast and accurate diagnosis, optimizing the initial assessment with contrast-enhanced CT and, when possible, urgent endoscopy.
Maintaining the principles of oncological surgery even in the emergency setting: adequate lymphadenectomy, oncological margins, total mesorectal excision when appropriate.
Individualizing treatment according to tumor location (colon cancer versus rectal cancer) and each patient's clinical situation.
Considering bridge-to-surgery strategies whenever possible: self-expanding colonic stents in left colon obstruction, diverting stomas or staged resections, to avoid emergency surgery when the patient's clinical situation allows it.

What this means in clinical practice

The SAGES recommendations give surgeons guidance based on the available evidence for a situation that has traditionally been handled case by case, with criteria that vary between hospitals. With shared criteria, a patient whose colorectal cancer first presents in the emergency department should receive similar treatment wherever they are operated on.

Commitment to research and colorectal surgery

At Quenet-Torrent Institute we are sharing this publication, which comes from our participation in international research on the surgical treatment of colorectal cancer.

Dr. Patricia Tejedor leads our institute's colorectal surgery unit, where we apply these recommendations to the treatment of colorectal cancer, both in elective surgery and in cases that need emergency care.

Read the full article

You can read the full article on the journal's website: Surgical Endoscopy: SAGES Clinical Spotlight Review.

FAQ

Frequently asked questions

The most common questions answered with concrete data.

What is SAGES and why do its recommendations matter?

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) is a US scientific society for digestive and endoscopic surgery. Many surgical teams in other countries use its clinical practice guidelines as a reference.

What is the article published in Surgical Endoscopy about?

It is a clinical spotlight review on the management of colorectal cancer that presents as an emergency, especially in cases of bowel obstruction, perforation or bleeding. It sets out practical recommendations based on the available evidence to standardize decision-making in these complex scenarios.

Why is colorectal cancer harder to treat in the emergency setting?

Emergency presentations are usually associated with more advanced tumors at the time of diagnosis, greater surgical complexity, the need for emergency surgery and worse oncological outcomes in the medium and long term compared with elective surgery. There is very little room for planning.

What bridge strategies does the article recommend before surgery?

The article recommends considering self-expanding colonic stents in left colon obstruction, diverting stomas or staged resections as alternatives to emergency surgery when the patient's situation allows it. These strategies reduce perioperative morbidity and mortality and make it possible to operate in better conditions.

Are oncological principles maintained even in emergency surgery?

Yes. The article stresses that the principles of oncological surgery must be preserved even in emergencies: adequate lymphadenectomy, oncological margins and total mesorectal excision when appropriate. Sacrificing oncological quality in an emergency compromises long-term outcomes.

Which diagnostic tests are recommended in the initial emergency assessment?

Contrast-enhanced CT is recommended as the main tool for fast diagnosis and staging. In selected cases it can be completed with urgent endoscopy to confirm the location of the tumor and assess whether an endoscopic stent can be placed as a bridge to elective surgery.

Is the approach different depending on whether the tumor is in the colon or the rectum?

Yes. The article highlights the need to individualize treatment according to location. Rectal cancer has specific anatomical and technical considerations, with a larger role for total mesorectal excision, while obstructing colon cancer can more often be managed with strategies such as an endoscopic stent.

What impact do these recommendations have on everyday clinical practice?

With shared international criteria, a patient with colorectal cancer in the emergency setting receives more consistent, evidence-based treatment, whichever center treats them. The aim is to reduce variability in decision-making.

How important is the center's experience in these emergency cases?

The experience of the surgical team is decisive in emergency situations. Centers specialized in colorectal surgery have access to more technical resources (urgent endoscopy, colonic stents, intensive care support), which allows them to apply the recommended strategies better and obtain oncological outcomes comparable to elective surgery.

What does it mean for the patient to be operated on in better conditions?

Operating in better conditions means doing it electively (as a scheduled operation) rather than as an emergency, with the patient stabilized, a multidisciplinary team prepared and the possibility of performing complete surgery that meets oncological criteria. This reduces postoperative complications and improves long-term survival.

How can colorectal cancer that first presents as an emergency affect the prognosis?

Emergency presentation is associated with diagnosis at more advanced stages, a higher rate of perioperative complications and worse oncological outcomes. However, correctly applying the recommended management strategies can bring outcomes closer to those of elective surgery and improve the prognosis.