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We intended to determine the incidence of the need for subsequent surgery in patients with palliative self-expanding metal stents (SEMS) placed for malignant colonic obstruction.A total of 204 patients had 223 SEMS placed for a malignant colorectal obstruction. After excluding 80 patients who underwent SEMS placement as a ‘bridge to surgery’, one hundred twentyfour patients with unresectable stage IV cancer [72 colorectal cancer (CRC), and 52 with other cancers (OC)] were retrospectively analyzed.The patency rates at 3 and 6 months were 62% and 50.1% in CRC group and 61% and 29.4% in the OC group (P = 0.123). The overall stent-related complication rate was 56.1% (78 stents). Complications requiring surgery occurred in 33 patients (23.6%). Although the overall complication rate was lower in the CRC group (48.1% vs 67.2%, P = 0.025), the need for surgery was similar (24.7% vs 22.0%, P = 0.383). Patency until surgery in the two groups was 93 ± 132 and 95 ± 118 days, respectively (P = 0.951). The most common indications for operation were reobstruction (42.4%) and perforation (27.3%). Chemotherapy did not affect the overall complication rate, and in patients who received chemotherapy, surgery was needed after 5 ± 3 (CRC) and 3 ± 3 (OC) cycles (P = 0.140).Our results indicate that a considerableproportion of patients having SEMS placed for palliative purposes later require surgical intervention.