Acute Presentations of Colorectal Cancer: An International Prospective Snapshot on Management and Outcomes

ABSTRACT Background Patients with colorectal cancer (CRC) present as an emergency in one‐third of cases. This international snapshot study describes the presentation, treatment, and overall outcomes of patients admitted acutely to hospital with CRC. Methods Acute presentation of colorectal cancer—an international snapshot (APOLLO) was a prospective, international, cohort study enrolling consecutive patients admitted acutely to hospital with CRC from January to June 2023. The primary outcome was mortality at 90 days. Reasons for acute CRC presentation are described, as are the rates of surgical and nonsurgical management and mortality. Results Overall, 1861 patients (257 centers, 39 countries) were included (median age 70 years; females 44.8%). Rates of obstruction (54.5%; 1015 of 1861) and perforation (11.4%; 212 of 1861) are quantified. In total, 59.2% of patients were managed with curative intent (1102 of 1861). Curative management of right colon cancer predominantly involved resection and primary anastomosis (RPA) (78.5%). Curative management of left colon cancer predominantly involved either RPA or resection with end stoma formation (RES) (42.9% vs. 40.6%). Acute curative rectal cancer management strategies were more heterogeneous (RPA 21.8%, RES 26.7%, diverting stoma only 15.8%, no surgery 31.5%). Overall 90‐day mortality was 17.5% (326 of 1861) and lower in those undergoing curative intent surgery (69 [7.3%] of 949). Conclusion This international prospective snapshot study found a 17.5% 90‐day mortality in patients presenting acutely with CRC, predominantly for obstruction. High levels of variation in the management of acutely presenting left colon cancer and rectal cancer are highlighted.