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

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 (20052010). 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.