{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T14:14:20Z","timestamp":1778854460266,"version":"3.51.4"},"reference-count":30,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T00:00:00Z","timestamp":1766966400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T00:00:00Z","timestamp":1766966400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Gastroent Surgery"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Although perforated colorectal cancer has a poor prognosis, it remains unclear whether this is attributed to the perforation itself or related clinicopathological factors indicating advanced tumor progression. We investigated the true prognostic impact of perforation in colorectal cancer after adjusting for perforation\u2010related clinicopathological factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective single\u2010center cohort study included 2073 patients underwent curative resection for primary colorectal cancer between January 2009 and December 2022 (73 with perforated colorectal cancer and 2000 with nonperforated colorectal cancer). Perforation\u2010related clinicopathological factors were identified by multivariate logistic regression and used for 1:2 propensity score matching as covariates. Recurrence\u2010free survival and overall survival were analyzed using Kaplan\u2013Meier estimates and Cox proportional hazards models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Independent perforation\u2010related clinicopathological factors were age \u2265\u200975\u2009years, left\u2010sided tumor, and pathological T Stage 4 (pT4). The perforated colorectal cancer group had a lower rate of minimally invasive surgery (62.5% vs. 90.6%), fewer harvested lymph nodes (medians: 13 vs. 16.5), and more frequent major postoperative complications (18.8% vs. 7.3%) compared to the nonperforated colorectal cancer group. Multivariate Cox analysis revealed that pT4 and perforation independently predicted worse recurrence\u2010free survival and overall survival. The hazard ratios were 2.71 and 2.54 for pT4 (95% confidence intervals: 1.45\u20135.04 and 1.08\u20135.9), and 2.67 and 3.30 for perforation (95% confidence intervals: 1.44\u20134.96 and 1.37\u20137.96), respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Perforation independently predicted poor prognosis in colorectal cancer, highlighting its distinct oncologic relevance beyond standard pathological staging. Prospective studies should establish individualized strategies to improve outcomes in perforated colorectal cancer.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ags3.70163","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T06:19:28Z","timestamp":1767075568000},"page":"779-791","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Independent Prognostic Significance of Perforation in Colorectal Cancer: Insights From a Propensity Score\u2010Matched Cohort Study"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9577-6519","authenticated-orcid":false,"given":"Yoshiaki","family":"Fujii","sequence":"first","affiliation":[{"name":"Department of Surgery Kariya Toyota General Hospital  Kariya Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuhei","family":"Ueno","sequence":"additional","affiliation":[{"name":"Department of Surgery Kariya Toyota General Hospital  Kariya Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshinaga","family":"Aoyama","sequence":"additional","affiliation":[{"name":"Department of Surgery Kariya Toyota General Hospital  Kariya Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroyuki","family":"Imafuji","sequence":"additional","affiliation":[{"name":"Department of Surgery Kariya Toyota General Hospital  Kariya Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takahisa","family":"Hirokawa","sequence":"additional","affiliation":[{"name":"Department of Surgery Kariya Toyota General Hospital  Kariya Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hirotaka","family":"Miyai","sequence":"additional","affiliation":[{"name":"Department of Surgery Kariya Toyota General Hospital  Kariya Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiro","family":"Kimura","sequence":"additional","affiliation":[{"name":"Department of Surgery Kariya Toyota General Hospital  Kariya Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenji","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Surgery Kariya Toyota General Hospital  Kariya Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuji","family":"Takiguchi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery Nagoya City University Graduate School of Medical Sciences  Nagoya Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,12,29]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13017-018-0192-3"},{"issue":"6","key":"e_1_2_10_3_1","first-page":"414","article-title":"Colorectal Cancer With Intestinal Perforation\u2014A Retrospective Analysis of Treatment Outcomes","volume":"18","author":"Banaszkiewicz Z.","year":"2014","journal-title":"Contemporary Oncology"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-015-2336-1"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.13262"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1067\/msy.2000.104674"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-022-02319-5"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12957-025-03783-5"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-016-3667-y"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12957-018-1530-3"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.21873\/invivo.12291"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/DCR.0b013e318197e351"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2007.02.027"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-019-02110-x"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1318.2007.01412.x"},{"issue":"1","key":"e_1_2_10_16_1","article-title":"Risk Factors and Patterns of Recurrence in Stage III Perforated Colorectal Cancer: A Single\u2010Center, Retrospective, Observational Study","volume":"17","author":"Asano H.","year":"2025","journal-title":"Cureus"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-016-2694-3"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-023-04559-7"},{"key":"e_1_2_10_19_1","volume-title":"TNM Classification of Malignant Tumours","author":"Brierley J. 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