Photo Credit: Mohammed Haneefa Nizamudeen

The following is a summary of “Factors associated with postoperative recurrence in perforated colorectal cancer: unraveling the high recurrence rate of perforated colorectal cancer,” published in the April 2025 issue of the World Journal of Surgical Oncology by Takagi et al.

Perforated colorectal cancer (CRC) is associated with a significantly higher recurrence rate compared to non-perforated forms of the disease, though the underlying causes of this disparity have not been fully elucidated. This study aimed to investigate the clinicopathological features and prognostic factors contributing to recurrence in patients with Stage II and III perforated CRC who underwent curative (R0) resection.

A retrospective analysis was conducted on consecutive patients treated at a single institution between 2007 and 2020. The study included patients diagnosed with Stage II or III perforated CRC who underwent radical resection. A comparison cohort comprised patients with non-perforated, non-obstructive CRC who underwent surgery during the same period. Clinical and pathological variables evaluated included age, sex, tumor location, surgical procedure, presence of stoma, T stage, lymphatic and venous invasion, tumor differentiation, the extent of lymph node dissection, number of dissected lymph nodes, lymph node metastasis, postoperative complications, and 30-day postoperative mortality. Recurrence data were analyzed for patients with at least three years of postoperative follow-up, up to a maximum of five years.

The analysis included 89 patients with perforated CRC and 323 with non-perforated CRC. Median age was comparable between the two groups (74 vs. 73 years). The perforated group exhibited a significantly higher proportion of T4 tumors (39% vs. 18%, p < 0.001) and a lower number of dissected lymph nodes (median 10 vs. 17, p < 0.001). Additionally, postoperative complications were significantly more common in the perforated group (46% vs. 7%, p < 0.001). Follow-up data were available for 55 perforated and 284 non-perforated cases. Univariate analysis identified perforation, T4 staging, lymph node metastasis, and postoperative complications as significant predictors of recurrence. However, multivariate analysis revealed that only T4 staging and lymph node metastasis remained as independent risk factors for recurrence.

The elevated recurrence rate observed in perforated CRC appears to be primarily driven by advanced tumor characteristics—particularly T4 stage and lymph node involvement—rather than perforation itself. These findings suggest that perforation is more likely a marker of disease severity rather than a direct cause of recurrence. Understanding the biological mechanisms linking advanced disease and tumor perforation warrants further investigation to improve risk stratification and postoperative management strategies.

Source: wjso.biomedcentral.com/articles/10.1186/s12957-025-03783-5