Colonic Stenting as a Bridge to Surgery Versus Emergency Resection in Obstructive Colon Cancer: A Systematic Review of Surgical Outcomes.

Background

Acute malignant colorectal obstruction requires urgent management, traditionally by emergency resection or stoma formation. Colonic stenting as a bridge to surgery (BTS) has emerged as an alternative, but concerns persist regarding oncologic safety. This systematic review evaluates short-term and long-term outcomes of BTS with self-expanding metal stents (BTS-stent) compared with acute resection (AR).

Methods

A systematic review was conducted on multiple databases. PubMed, Cochrane Library, and Google Scholar were searched for studies published between 2015 and 2025 reporting surgical management of obstructive colon cancer. Outcomes included perioperative morbidity and mortality, laparoscopic conversion, stoma formation, stent-related complications, and long-term overall survival (OS) and disease-free survival (DFS). Data were synthesized descriptively with reference to reported comparative effects and prior meta-analyses.

Results

Fifteen studies published between 2015 and 2025 were included, encompassing 6999 patients (AR: 4944; BTS-stent: 1739; other BTS: 311). BTS was associated with higher rates of laparoscopic surgery (57% vs. 14%) and primary anastomosis, and significantly reduced stoma formation (27% vs. 60%). Postoperative morbidity and 30-day mortality were lower or comparable in BTS cohorts (4.9% vs. 7.8%). SEMS technical success ranged from 78 to 97%, with perforation rates of 0-15%, representing the main adverse event. Long-term outcomes were comparable between groups. Five-year OS ranged from 46 to 75% (BTS) and 46 to 74% (AR), with similar DFS. Subgroup data suggested possible worse outcomes in T4 tumors and improved results in selected stage III patients. Delayed surgery (>4 weeks) may improve survival, but increases complication risk.

Conclusions

BTS with SEMS improves short-term outcomes without compromising long-term survival. Careful selection and avoidance of perforation are essential.