Long-term mortality and recurrence after colorectal cancer surgery with preoperative stenting: a Danish nationwide cohort study

• Published in: Endoscopy Vol. 47; no. 6; p. 517
• Main Authors: Erichsen, Rune, Horváth-Puhó, Erzsébet, Jacobsen, Jacob Bonde, Nilsson, Tove, Baron, John A, Sørensen, Henrik Toft
• Format: Journal Article
• Language: English
• Published: Germany 01.06.2015
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Colorectal Neoplasms - complications; Colorectal Neoplasms - mortality; Colorectal Neoplasms - surgery; Denmark; Elective Surgical Procedures; Emergencies; Female; Follow-Up Studies; Humans; Incidence; Infant; Intestinal Obstruction - etiology; Intestinal Obstruction - therapy; Male; Middle Aged; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - etiology; Preoperative Care - adverse effects; Preoperative Care - methods; Registries; Self Expandable Metallic Stents - adverse effects; Survival Analysis; Treatment Outcome; Young Adult; Denmark
• ISSN: 1438-8812
• DOI: 10.1055/s-0034-1391333

Self-expanding metal stents (SEMS) used as a bridge to surgery for obstructive colorectal cancer (CRC) have fallen under suspicion for inducing tumor dissemination, and thereby increasing recurrence risk and long-term mortality. The aim of this study was to compare overall mortality and CRC recurrence in patients receiving preoperative SEMS vs. patients undergoing urgent resection. This was a Danish, nationwide, population-based cohort study (2005 - 2010). For patients with CRC who survived the first 30 days after resection, the long-term survival in terms of mortality rate ratios was assessed using Cox regression with adjustment for important covariates. For patients with Dukes' A - C disease only, recurrence risk was similarly assessed using incidence rate ratios. The 5-year survival was 49 % among 581 patients with preoperative SEMS and 40 % among 3333 patients undergoing urgent resection, corresponding to an adjusted mortality rate ratio of 0.98 (95 % confidence interval [CI] 0.90 to 1.07). For patients with Dukes' stage A - C disease, the 5-year recurrence risk was 39 % among 286 patients after preoperative SEMS and 30 % among 1627 patients after urgent resection, corresponding to an adjusted incidence rate ratio of 1.12 (95 %CI 0.99 to 1.28). Long-term mortality associated with the use of SEMS as a bridge to surgery was comparable to that of urgent resection. SEMS use may be associated with an increased CRC recurrence risk.