Self-expanding metal stent as a bridge to elective surgery versus immediate emergency surgery in left-sided obstructive colorectal cancer: a retrospective comparative study.

Abstract

Left-sided colorectal obstruction represents a formidable challenge in colorectal cancer management, often necessitating urgent intervention. Although self-expanding metal stents (SEMS) may act as a bridge to more controlled, elective surgery, the question remains whether this strategy confers measurable advantages over immediate emergency surgery (ES). We conducted a single-center, retrospective study comparing outcomes in patients with left-sided colorectal obstruction who underwent either SEMS placement followed by elective resection or direct ES. Between January 2018 and August 2023, 189 eligible patients were included. Perioperative variables, stoma formation, operative blood loss, and survival rates were documented. Kaplan-Meier analyses were performed to assess overall and disease-free survival in both groups. Of the 99 patients allocated to the SEMS group, 98 achieved successful stent deployment and 89 (91%) proceeded to elective surgery without stent-specific complications. Compared with the 100 patients in the ES group, the SEMS cohort exhibited significantly lower intraoperative blood loss (p < 0.001) and an increased rate of minimally invasive surgeries (p < 0.001). While all patients in the ES group underwent colostomy, only 80 in the SEMS group required ileostomy, and an additional 9 underwent primary anastomosis without a diversion. Ileostomy closure was completed more frequently (p = 0.002) and required less operative time (p < 0.001) than colostomy closure, resulting in reduced hospitalization. No significant differences in overall survival (p = 0.091) or disease-free survival (p = 0.22) were observed between the two treatment groups. In selected patients with obstructing left-sided colorectal cancers, SEMS placement as a bridge to elective surgery may reduce operative trauma, facilitate minimally invasive procedures, and lessen the burden of stoma formation, all without compromising long-term oncologic outcomes. Careful patient selection and strict procedural vigilance are fundamental to ensuring the safe adoption of this strategy.