Vascular and Perineural Invasion as Hidden Predictors of Early Morbidity and Mortality After Colorectal Cancer Surgery

Abstract

Objective: Vascular invasion (VI) and perineural invasion (PNI) are established adverse prognostic factors in colorectal cancer (CRC). However, their impact on early postoperative outcomes has been less frequently studied.

Methods: A retrospective cohort of 685 patients who underwent curative colorectal cancer surgery between 2012 and 2022 was analyzed. Demographic, pathological, and clinical data were collected. Vascular invasion and PNI status were assessed in resection specimens. The primary outcomes were postoperative complications and 30-day mortality. Statistical analyses included chi-square tests, logistic regression, and survival analyses.

Results: Vascular invasion was detected in 30% of patients, while PNI was observed in 25%. The coexistence of VI and PNI occurred in 12% of cases. Patients with both invasion types demonstrated significantly higher postoperative complication rates (52% vs. 29%, P < .001) and increased 30-day mortality (15% vs. 6%, P = .002) compared with those without invasion. Vascular invasion and PNI were also associated with higher lymph node positivity and advanced tumor stage. On multivariate analysis, combined VI/PNI remained an independent predictor of postoperative morbidity (odds ratio [OR]: 2.1, 95% CI: 1.4-3.3) and early mortality (OR: 2.7, 95% CI: 1.5-4.9).

Conclusion: Vascular and perineural invasion are not only indicators of tumor aggressiveness but also predictors of early postoperative risk in colorectal cancer. Their coexistence identifies a subgroup of patients with particularly poor short-term outcomes. Routine pathological reporting of VI and PNI should be emphasized, and their presence considered in perioperative risk stratification and adjuvant decision-making.

Cite this article as: Öçal D, Torun M. Vascular and perineural invasion as hidden predictors of early morbidity and mortality after colorectal cancer surgery. Cerrahpaşa Med J. 2026, 50, 0082, doi: 10.5152/cjm.2026.25082.