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Little is reported in the literature on management strategies and outcomes in patients with an active cancer diagnosis who undergo emergent general surgery. The purpose of this study is to evaluate preoperative risk factors in both operative and non-operative management, as well as to describe the outcomes of colonic emergencies within a cancer patient population.A single institution cancer database was reviewed retrospectively to identify patients with an active cancer diagnosis who had an emergency general surgery consult placed for an acute colonic pathology.A total of 87 patients were included. Among these, 38 patients underwent operative and 49 underwent nonoperative management. There was a 71% rate of postoperative complications in the operative group; these patients were also more likely to require intensive care unit admission (P < .001), die during their hospitalization (P=.003), have a greater 30-day mortality (P=.001) and were less likely to be discharged to home (P < .001). No patients in the nonoperative group required admission to the intensive care unit, 3 of the 49 (6%) died during their hospitalization, and 75% of nonoperative patients were discharged to home.When clinically appropriate, patients with active cancer who present with an acute colonic emergency can undergo nonoperative management safely. In contrast, patients undergoing operative management have a substantial risk of morbidity and mortality.