Objective: Even after surgery and intensive postoperative treatment, the mortality rate of patients with perforated colorectal cancer (CRC) is high. The purpose of this retrospective study was to evaluate risk factors for postoperative recurrence and hospital mortality in patients with perforated CRC.

Patients and Methods: We experienced a total of 142 patients who were diagnosed with colorectal perforation and who underwent emergency surgery from 2008 to 2021. First, we performed a clinicopathological study of patients with perforated CRC. Next, we examined the clinicopathological characteristics of the CRC and non-CRC groups. We investigated the histopathological characteristics and risk factors for postoperative recurrence and hospital mortality in 32 patients with perforated CRC.

Results: The Hinchey stage of the CRC group was significantly higher than that of the non-CRC group (p=0.00619), and that in the proximal site group was significantly higher than that of the cancer site group (p=0.00489). The rate of recurrence in the proximal site perforation group was significantly higher than that in the cancer site perforation group (p=0.0135). Patients with T4 disease showed a significantly higher rate of recurrence than those with T3 disease (p=0.0443). The number of dissected lymph nodes in the recurrence-free group was significantly higher than that in the recurrence group (p=0.0377). There was a tendency for more patients in the recurrence-free group to receive postoperative adjuvant chemotherapy; however, this difference was not statistically significant. The preoperative shock rate in the hospital mortality group was significantly higher than that in the alive at discharge group (p=0.0169).

Conclusions: The proximal site perforation, T4 disease, and the small number of dissected lymph nodes were the risk of the recurrence. The large number of preoperative shocks was the risk of the hospital mortality.