Early-Onset Colorectal Cancer: Clinicopathological Features and Surgical Outcomes in Patients Treated with Curative Intent at a Tertiary Center

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Background: The incidence of early-onset colorectal cancer (EOCRC) has increased worldwide and now represents approximately 10% of colorectal cancers in high-income countries. EOCRC is frequently associated with advanced pathological features, although its clinical behavior and optimal management remain incompletely defined. Methods: We performed a retrospective single-center study including 88 consecutive patients aged ≤50 years who underwent curative-intent colorectal cancer resection between January 2019 and December 2023 at a tertiary referral center. Perioperative outcomes, pathological characteristics, and recurrence patterns were analyzed. Results: The median age was 44 years, and 67% of tumors were located in the colon. Pathological nodal involvement (pN+) was observed in 47.7% of patients, with a high prevalence of adverse features including perineural invasion (62.5%), tumor budding (17.0%), and tumor deposits (15.9%). Minimally invasive surgery was performed in 79% of patients and was associated with shorter hospital stay without increased postoperative morbidity (19.3%). During a median follow-up of 31.3 months [IQR 21.6–44.6], recurrence occurred in 40 patients (45.5%) and was predominantly distant (75.0%). Among patients with recurrence, 21 (52.5%) underwent surgical reintervention, most commonly hepatic and pulmonary resections. Rectal cancer was associated with higher rates of stoma formation and major postoperative complications compared to colon cancer. Conclusions: EOCRC is characterized by a high prevalence of adverse pathological features and a substantial rate of distant recurrence. However, a relevant proportion of recurrences remains amenable to surgical treatment in selected patients. Management in a specialized tertiary center allows achievement of high-quality surgical outcomes and supports an aggressive multidisciplinary approach.

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