mize patient outcomes, the National Comprehensive Cancer Network (NCCN) pro­vides comprehensive guidelines for the manage­ment of colorectal cancer patients. These guidelines emphasize the importance of meticu­lous surgical techniques and thorough pathologi­cal examination. Specically, the NCCN recommends the identication and examination of lymph nodes at the origin of feeding vessels, with a minimum of 12 lymph nodes required to establish the appropriate N stage [7].

The determination of the optimal resection margin goes beyond mere length considerations. The site of proximal and distal transection is also inuenced by factors such as vascular ligation, performed in conjunction with lymphadenec­tomy. This ensures that the resection encom­passes the tumor and its associated lymphatic drainage, thereby reducing the risk of local recur­rence and improving oncologic outcomes. By tai­loring the resection margins to the specic characteristics of the tumor and its anatomical location, surgeons can achieve maximal tumor clearance while preserving vital structures and function.

Emergent resection of locally advanced rectal cancer without prior multimodal therapy is strongly discouraged as it may compromise the patient’s oncologic outcome. The omission of neoadjuvant treatment in such cases can heighten the complexity of surgical intervention, increase the risk of intraoperative complications, and compromise the potential for achieving optimal oncologic control.

By adopting a holistic approach that integrates surgical, oncologic, and supportive care strate­gies, healthcare providers can effectively address the emergent needs of patients while safeguard­ing their long-term oncologic outcomes. Collaboration among diverse medical specialties is essential in ensuring comprehensive and personalized care for individuals facing colorec­tal cancer emergencies.

Following excision of an appropriately sized disc of skin at the designated location, it is impor­tant to divide the subcutaneous tissue rather than excising or “coring out” it [14]. A vertical inci­sion of 2–3cm in the anterior fascia, followed by a perpendicular 1cm fascial incision, should be made. Subsequently, the rectus muscle should be split in the direction of its bers, and a major ver­tical incision in the posterior rectus sheath is war­ranted. Attention should be paid to ensuring the mesentery of the bowel wall is not twisted during this process.

In obese patients, where passing the bowel wall may pose difculty, utilizing a surgical glove [15] or wound protector [16] had been described to facilitate easier passage of the bowel through the trephine. In scenarios such as distal obstruction with markedly dilated bowel, an oversized fascial incision may occasionally be necessary. However, this may increase the risk of developing a clinically signicant parastomal hernia, thus tightening the fascia once the bowel has been delivered is advisable.

stoma retraction among patients was found to be

Regrettably, the average BMI measurement did not account for obese patients, who typically face more complex challenges during stoma cre­ation. This highlights a potential limitation in the study’s ndings. Moreover, as per the 2022 prac­tice parameters set forth by the American Society of Colon and Rectal Surgery, the routine use of prophylactic mesh to prevent parastomal hernias during stoma creation is no longer recommended [19].

The lateral approach involves rst mobilizing the lateral peritoneal attachments, commonly known as mobilizing the white line of Toldt. The colon and mesocolon are elevated away from the retroperitoneum in the avascular plane. Efforts not to violate the fascia of the mesocolon should be made to ensure its intact excision. The omen­tum was separated from the transverse colon and once fully mobilized, attention is placed upon the ileocolic pedicle to aid in its identication. Ligation is performed at its origin from the supe­rior mesenteric vessels. The mesentery of the ter­minal ileum is divided to achieve at least a 5cm margin from the ileocecal valve. The right branch of the middle colic artery is identied by elevat­ing the transverse colon and should be ligated lesions of the right colon. The decision of whether to perform an anastomosis in an oncologic emer­gency is complex and depends on multiple fac­tors. The patient’s overall condition and the degree of abdominal hostility are important con­siderations. Ileocolonic anastomoses typically have favorable standard leak rates ranging from 1 to 3% [11]. However, creating an ileostomy poses risks for complications such as high output, leak­age, prolapse, herniation, mucocutaneous retrac­tion, separation, and ischemia.