Self-expandable metal stents as a bridge to surgery for obstructive colorectal cancer: a propensity score-matched retrospective cohort study.

Abstract

Purpose: Acute colorectal obstruction constitutes a surgical emergency in patients with colorectal cancer (CRC) and is associated with high morbidity and mortality when managed with emergency surgery. Although self-expandable metal stents (SEMS) may optimize surgical conditions, concerns remain regarding their long-term oncologic safety.

Methods: This retrospective cohort study included 355 patients with obstructive CRC treated between 2014 and 2023, including 65 patients in the SEMS group and 290 in the surgery-alone group. Perioperative outcomes, postoperative complications, disease-free survival (DFS), and overall survival (OS) were compared. Propensity score matching and multivariate Cox regression were applied to reduce selection bias and adjust for confounding factors.

Results: Patients in the SEMS group had a markedly higher rate of laparoscopic surgery (89.2% vs. 62.8%, p < 0.001) as well as a significantly shorter postoperative hospital stay (11.05 ± 5.25 vs. 14.29 ± 11.86 days, p = 0.032). No significant differences were observed in overall postoperative complications, DFS, or OS between the two groups after adjustment. Although a higher crude recurrence rate, particularly intra-abdominal recurrence, was observed in the SEMS group, SEMS placement was not an independent predictor of adverse oncologic outcomes.

Conclusion: SEMS as a bridge to surgery was associated with improved perioperative outcomes and showed no statistically significant adverse impact on long-term survival after adjustment for confounding factors. Further prospective studies are required to confirm oncologic safety in selected patients.