Background Oncologic surgical emergencies (OSEs) are increasing, with rising cancer incidences and prolonged patient survival. However, prior OSEs studies have been limited by a narrow focus. This study aimed to determine whether a five-category classification for OSEs can effectively guide clinical decision-making based on patient outcomes. Methods This retrospective cohort study used prospectively collected data from 1 May 2015 to 31 December 2023 at Zhongshan Hospital, Fudan University. Among in-patients undergoing emergency general surgery, 2908 patients with OSEs were included. The OSEs were classified into five categories based on the tumor course: (1) emergency as the initial symptom, (2) emergency due to tumor progression or recurrence, (3) complications from non-invasive treatments, (4) complications from invasive treatments, and (5) emergencies unrelated to tumors but with a history of malignancy. The primary outcome was in-hospital mortality. Results Obstruction was the most common emergency (58.0%), and gastrointestinal tumors were the primary source (79.8%). Category 1 emergencies were the most frequent (42.8%), followed by categories 2 (16.4%), 4 (16.0%), 5 (19.5%), and 3 (5.5%). The patients with OSEs had a higher in-hospital mortality rate than those with other types of emergencies (4.0% vs. 1.5%; p < 0.001). Perforation, age ≥ 65 years, and male sex were independent risk factors for in-hospital mortality. Conclusions The comprehensive five-category classification system for OSEs provided a valuable framework that may enhance clinical decision-making and guide management strategies for this patient population. Thus, it has potential to be integrated into clinical practice.

Background Leiomyosarcomas of the inferior vena cava (IVC) pose significant surgical challenges, particularly when tumors extend to the hepatic veins (HVs) and the heart. Such cases often necessitate innovative surgical strategies involving complex vascular and organ reconstruction.1–6 Patient and Methods The patient is a 61-year-old female with a large expansile IVC leiomyosarcoma extending into the right atrium and involving the atrial septum. Imaging revealed complete occlusion of the IVC and all major HVs. Results The tumor was resected en bloc, along with the whole liver, IVC, and portions of both atria under cardiopulmonary and portosystemic bypass. The atria and septum were reconstructed with bovine pericardial patches. The vena cava was reconstructed with a ringed Gore-Tex graft. Simultaneously at the back table, tumor resection and HV thrombectomy were performed. The hepatic vein outflow was reconstructed with a bovine pericardial patch. The tumor-free liver was then reimplanted. Operative time was 13 h 11 min, with an estimated blood loss of 4 L. The patient was then discharged home 1 month later. After 9 months, two small recurrent liver lesions were identified and addressed with partial liver resection following chemotherapy. The patient was alive and disease-free 16 months after initial surgery. Conclusions This case highlights the successful use of ex vivo surgery and liver autotransplantation in managing an extensive IVC leiomyosarcoma. This innovative approach, combined with open heart surgery, achieved complete tumor resection with a reasonable postoperative recovery and oncologic outcome.