Endoscopy 2015; 47(06): 517-524
DOI: 10.1055/s-0034-1391333
Original article
© Georg Thieme Verlag KG Stuttgart · New York

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

Rune Erichsen
1   Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
,
Erzsébet Horváth-Puhó
1   Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
,
Jacob Bonde Jacobsen
1   Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
,
Tove Nilsson
1   Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
,
John A. Baron
1   Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
2   Department of Medicine, Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
,
Henrik Toft Sørensen
1   Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
› Author Affiliations
Further Information

Publication History

submitted 21 February 2014

accepted after revision 27 November 2014

Publication Date:
15 January 2015 (online)

Background and study aims: 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.

Patients and methods: 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.

Results: 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).

Conclusions: 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.

Table e4 and Appendix e1

 
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