Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Gastroenterol. Oct 21, 2026; 32(39): 119719
Published online Oct 21, 2026. doi: 10.3748/wjg.119719
Published online Oct 21, 2026. doi: 10.3748/wjg.119719
Alarm from the peritoneum: Gastrointestinal perforations in cancer patients, with a focus on perforations of unknown origin
Manlio Monti, Bianca Ceredi, Nicolò Paganelli, Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola 47014, Emilia-Romagna, Italy
Roberto Vespignani, Department of Servizio Informatico, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola 47014, Emilia-Romagna, Italy
Alice Andalò, Paolo De Angelis, Nicola Gentili, Department of Data Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola 47014, Emilia-Romagna, Italy
Ilaria Massa, Andrea Roncadori, Valentina Danesi, William Balzi, Department of Outcome Research, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola 47014, Emilia-Romagna, Italy
Author contributions: Monti M, Massa I, Balzi W, Roncadori A and Danesi V participated in the conception and design of the study and in the interpretation of data; Roncadori A was involved in the analysis; Monti M wrote the manuscript with the assistance of Danesi V; Vespignani R, Balzi W, Andalò A, De Angelis P and Gentili N were involved in the acquisition and access of data; Ceredi B and Paganelli N verified the study data; all authors critically reviewed and provided final approval of the manuscript; and all authors were responsible for the decision to submit the manuscript for publication.
AI contribution statement: An AI-assisted tool was used only for language polishing and editing for response to reviewers. It was not used for data analysis, study design, interpretation of results, or image generation.
Supported by Ricerca Corrente by the Italian Ministry of Health.
Institutional review board statement: This investigation was approved by the Comitato Etico della Romagna (Romagna Ethics Committee; Approval No. 1517).
Informed consent statement: This was a retrospective single-center study based on secondary use routinely collected clinical data. No informed consent was obtained in accordance with article 110-bis of the Italian Data Protection Code.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Corresponding author: Valentina Danesi, PhD, Department of Outcome Research, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Via Piero Maroncelli, 40, Meldola 47014, Emilia-Romagna, Italy. valentina.danesi@irst.emr.it
Received: February 5, 2026
Revised: March 16, 2026
Accepted: May 21, 2026
Published online: October 21, 2026
Processing time: 214 Days and 9.1 Hours
Revised: March 16, 2026
Accepted: May 21, 2026
Published online: October 21, 2026
Processing time: 214 Days and 9.1 Hours
Core Tip
Core Tip: In this single-center retrospective study, a small but clinically relevant subset of gastrointestinal perforations occurred without an identifiable cause. Patients with perforation of unknown origin showed distinctive clinical and pathological features compared with cancer-related and cancer-unrelated cases, including a higher burden of comorbidities, particularly arterial hypertension, a different distribution of primary tumors (lung and kidney cancers), and preferential involvement of the colon and small intestine. Although outcomes appeared broadly comparable across groups, these findings suggest that patient-related factors may contribute to spontaneous perforation, highlighting an under-recognized clinical scenario in oncology practice.