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Mortality was adjusted for demographics, comorbid conditions and perioperative factors. Referring to the NSQIP database, a total of 80,275 cancer patients were analysed, 11.8% (9,423) of whom had metastatic cancer. Dyspnoea at rest/moderate exertion (OR 5.7/2.4; 95% CI 2.7/1.6-11.9/3.7; p 0.0001) were found to be the biggest predictors of in-hospital mortality in stage IV cancer patients who underwent emergent surgery. Dyspnoea at rest and with moderate exertion may be used as predictors of in-hospital mortality for metastatic cancer