Abstract:Objective: Emergency presentation of colon cancer is common, and it is associated with highmortality and morbidity following initial surgical treatment. The purpose of this study was toevaluate postoperative mortality and complications in a consecutive and population based series.Methods: All patients with adenocarcinoma of the colon diagnosed between 1993 and 2007 wereregistered prospectively. Mortality and complication rates for elective and emergency patients werecompared. Logistic regression analysis was used to identify independent risk factors forpostoperative complications.Results: In the study period 1129 patients were admitted, 237 (21 %) of whom presented as anemergency. A total of 1001 (89%) patients underwent surgical treatment; 926 patients (82%) had amajor resection, and the mortality rate was 3.5 % after elective and 10 % after emergency operation(p<0.01). The complication rate was 24 % and 38 % (p< 0.01), respectively. In patients with leftsided obstruction, the mortality rate after Hartmann’s procedure was 19 % as compared to 3 % afterresection with primary anastomosis (p< 0.01). Following surgery without tumour resection, themortality was 17 % and 24 % after elective and emergency operation, respectively.Multivariate analyses demonstrated that emergency operation, increasing age, advanced tumourstage and ASA class IV were independent risk factors for postoperative mortality.Conclusions: Emergency operation for colon cancer was associated with high mortality andcomplication rates also in this series, indicating that immediate surgery should be avoided ifpossible. Resection with primary anastomosis is probably preferable to Hartmann’s procedure inleft sided colon obstruction if non-operative treatment by endoluminal stenting fails.