Stent placement is associated with long delays in elective colorectal cancer surgery

Patients with coronary artery disease undergoing elective surgery for colorectal cancer had a long delay in the operation after receiving a stent, according to a Veterans Affairs analysis.

The median time from diagnosis to surgery was 100 days for patients receiving a stent after a colonoscopy and 42 days for patients who already had a stent implanted when they underwent a colonoscopy.

Lead researcher John T. Killian, Jr., MA, of the University of Alabama and colleagues published their findings online in JAMA Surgery on Oct. 21.

For patients with colorectal cancer who underwent PCI, guidelines recommend delaying elective surgery for 30 days for bare metal stents and for 6 to 12 months for drug-eluting stents, according to the researchers.

Of the 632 patients in this study, 31 percent had a coronary stent placed within two years before undergoing surgery for colorectal cancer. Of the patients who received a stent before a diagnostic colonoscopy, 54 percent received a drug-eluting stent and 66.7 percent had the stents placed for acute coronary syndrome. However, of the patients who received a stent after a diagnostic colonoscopy, 85.7 percent received a bare metal stent and 68.6 percent had the stents placed for a non-acute coronary syndrome indication.

At one year, the mortality rate was 9.7 percent. The researchers said the timing of the placement of the stent relative to the surgery date and the time from diagnostic colonoscopy to surgery were not significantly associated with mortality.

Within 30 days of surgery, major adverse cardiac events (MACE) occurred in 5.9 percent of the patients, including 4.8 percent of patients who received no stent, 7.1 percent of patients who had a stent placed before colonoscopy and 10 percent of patients who had a stent placed after colonoscopy.

The researchers defined MACE as MI, coronary revascularization or all-cause mortality.

“In our study, patients with a stent showed a nonsignificantly higher MACE rate of 10 percent that is similar to the rates reported for other patients undergoing surgery within 60 days of stent placement,” they wrote. “The urgency of a cancer operation may expose patients to additional risk by shortening the interval between stent placement and surgery, and this risk should be considered in the cardiovascular management of these patients.”