Delay of surgery after stent placement for resectable malignant colorectal obstruction is associated with higher risk of recurrence

• Published in: International journal of colorectal disease 2017-04, Vol.32 (4), p.513-516
• Main Authors: Broholm, Malene, Kobborg, Martin, Frostberg, Erik, Jeppesen, Maja, Gögenür, Ismail
• Format: Article
• Language: English
• Subjects: Aged; Cancer; Colorectal Neoplasms - surgery; Complications and side effects; Demography; Diseases; Female; Gastroenterology; Gastrointestinal diseases; Hepatology; Humans; Intention to Treat Analysis; Internal Medicine; Intestinal Obstruction - drug therapy; Intestinal Obstruction - surgery; Logistic Models; Male; Medicine; Medicine & Public Health; Metastasis; Oncology, Experimental; Original Article; Proctology; Recurrence; Relapse; Risk Factors; Stent (Surgery); Stents; Surgery; Survival Analysis; Time Factors; Treatment Outcome
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-016-2705-4

Background Self-expanding metal stents can be used as bridge to elective surgery for acute malignant colonic obstruction. However, the impact on long-term oncological outcome and the optimal timing of surgery are still unknown. Method This was a retrospective multicenter study performed at four colorectal centers. Patients undergoing stent placement as bridge to surgery, between January 2010 and December 2013, were included in the study. Primary outcomes were survival and recurrence rates along with location of the metastases. Additionally, we recorded time from stent placement to elective surgery. Secondary outcomes were postoperative complication rates. Complications were classified according to the Clavien-Dindo classification score. A logistic regression model was used to describe impact of delayed stent removal on risk of recurrence. Results This study included 112 patients, with a median follow-up of 43 months. Survival rate was 70%. We found a recurrence rate of 37%, primarily local recurrences (17%). Procedure-related complications at the stent placement were seen in 18%, and complications after subsequent elective surgery were seen in 39%. A significantly higher risk of recurrence with increased time from stent placement to elective surgery (OR 5.1 [1.6–15.8], p =  0.005) was found. Conclusion Delay of elective surgery after stent placement may have a negative influence on long-term oncologic outcomes.