Colorectal cancer: Greater neo-angiogenesis, less perforation, worst oncological outcomes

Little attention has been paid to the anatomopathological factors and pathophysiologic mechanisms involved in CRC perforation. Perforation is one of the most serious complications occurring up to 11% of the cases and may also be the first manifestation of the tumor. Differentiation and angiogenesis have an important role in the tumor perforation mechanism. On the one hand, a greater expression of vascularization optimizes the supply of oxygen to the tumor and thus entails a lower necrotic wall rate and thus of perforation, on the other it is associated with a lower rate of differentiation and hence to a more aggressive cancer cells.