Postoperative colonic ischemia is rare but significantly impacts outcomes after elective colectomy for colorectal cancer.

• Occurred in 0.27% of patients; highest rates seen in left hemicolectomy (0.52%) and transverse colectomy (0.47%).
• Patients with ischemia had a median Charlson comorbidity index of 3 versus 2 in those without (p < .001).
• It is linked to a 20.2% reoperation rate and 23.5% in-hospital mortality, compared to 0.96% and 0.95%, respectively, in non-ischemic cases.

Surgeons should consider vascular comorbidities and resection types when assessing patient risk and consider intraoperative perfusion techniques to minimize complications.