Coronary stent placement tied to delay in colorectal cancer surgery

Reuters Health Information: Coronary stent placement tied to delay in colorectal cancer surgery

Coronary stent placement tied to delay in colorectal cancer surgery

Last Updated: 2015-10-29

By Shannon Aymes

NEW YORK (Reuter Health) - Patients who have had a stent placed for coronary artery disease (CAD) face delays in colorectal cancer surgery, according to a new study.

"Coronary artery disease and colon cancer are highly prevalent among older Americans," said Dr. Mary T. Hawn of Stanford University School of Medicine in Stanford, California.

"Advances in coronary revascularization with drug eluting stents (DES) led to recommendations to delay elective surgery for 365 days among patients with DES due to the risk of stent thrombosis with holding anti-platelet therapy for surgery," she told Reuters Health by email.

Because there is conflicting literature on the impact of delaying surgical intervention on colorectal cancer outcomes, Dr. Hawn and colleagues looked at postoperative outcomes and timing of surgery in patients with a colorectal cancer diagnosis in the setting of coronary artery stenting.

Their findings were published as a research letter in JAMA Surgery, online October 21.

The researchers identified 632 Veterans Affairs patients with CAD who had elective surgery for colorectal cancer; 196 had had a stent placed within two years prior to surgery.

The median time from colorectal cancer diagnosis to resection was 42 days for patients whose stent had been placed before colonoscopy and 100 days for those with stent placement after colonoscopy (p<0.001).

The 30-day rate of major adverse cardiac events was 4.8% among patients with no stent, 7.1% among those with a stent placed before colonoscopy, and 10.0% among those who had a stent placed after colonoscopy (p=0.18).

There were no significant differences in one-year mortality rates either, with an overall rate of 9.7% in the entire cohort, the researchers say.

"Among patients with a recent diagnosis of colon cancer, assessment of coronary artery disease and revascularization should follow current guidelines," Dr. Hawn said.

"While it is intuitive that improving coronary blood flow would decrease the risk of cardiac events, this has not been borne out in studies. And in fact, operating on patients with recent stents, regardless of type of stent, is associated with higher risk of events in the peri-operative period," she added.

The team concludes, "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."


JAMA Surg 2015.

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