title: Delay of surgery after stent placement for resectable malignant colorectal obstruction is associated with higher risk of recurrence.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Delay of elective surgery after stent placement may have a negative influence on long-term oncologic outcomes.
authors.affiliation: Center for Surgical Science, Department of Surgery, Zealand University Hospital, Copenhagen University, København, Denmark. malenebroholm87@gmail.com.
authors.forename: Malene
authors.identifier: http://orcid.org/0000-0002-0996-8048
authors.initials: M
authors.lastname: Broholm
authors.affiliation: Department of Surgery, Aabenraa Hospital, Aabenraa, Denmark.
authors.forename: Martin
authors.initials: M
authors.lastname: Kobborg
authors.affiliation: Department of Surgery, Vejle Hospital, Vejle, Denmark.
authors.forename: Erik
authors.initials: E
authors.lastname: Frostberg
authors.affiliation: Center for Surgical Science, Department of Surgery, Zealand University Hospital, Copenhagen University, København, Denmark.
authors.forename: Maja
authors.initials: M
authors.lastname: Jeppesen
authors.affiliation: Center for Surgical Science, Department of Surgery, Zealand University Hospital, Copenhagen University, København, Denmark.
authors.forename: Ismail
authors.initials: I
authors.lastname: Gögenür
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000601:surgery*; D003710:Demography; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D007415:Intestinal Obstruction / Q000188:drug therapy / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D012008:Recurrence; D012307:Risk Factors; D015607:Stents; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
keywords: Bridge to surgery; Oncological outcome; Self-expandable metal stents