Short-term outcomes of bridge-to-surgery using self-expanding metallic stents in robotic colorectal surgery for obstructive left-sided colorectal cancer: a consecutive cohort study.

BACKGROUND

Obstructive colorectal cancer is associated with substantial morbidity and stoma formation. Bridge-to-surgery (BTS) using self-expanding metallic stents (SEMS) can convert emergency surgery into an elective procedure, but evidence in robotic colorectal surgery remains limited. This study evaluated the feasibility of SEMS-based BTS in robotic surgery for obstructive left-sided colorectal cancer.

METHODS

This retrospective single-center cohort study included consecutive patients who underwent robotic colorectal resection between February 2023 and December 2025. After excluding right-sided colon cancer, 161 patients were analyzed: 37 underwent BTS and 124 underwent upfront elective surgery. Propensity score matching using preoperative variables generated 36 matched pairs. The primary outcome was major postoperative complications, defined as Clavien-Dindo grade ≥ III complications. Secondary outcomes included perioperative outcomes, robotic intraoperative metrics, and short-term oncological surrogate outcomes.

RESULTS

After matching, robotic intraoperative metrics showed no statistically significant differences between the non-BTS and BTS groups, including console time (136.50 vs. 148.00 min, P = 0.166), total operative time (250.00 vs. 274.50 min, P = 0.205), estimated blood loss (3.00 vs. 3.00 mL, P = 0.936), and conversion to open surgery (0% in both groups). Major postoperative complications occurred in one patient (2.8%) in the non-BTS group and in none in the BTS group (P = 1.000). Although the BTS group included more pathologically advanced tumors, R0 resection among patients with Stage I-III disease was achieved in 96.3% and 100.0% of patients, respectively. CEA levels at 3 months postoperatively were not significantly different between groups.

CONCLUSIONS

SEMS-based BTS appears feasible for selected patients undergoing robotic surgery for obstructive left-sided colorectal cancer. BTS was not accompanied by increased short-term morbidity or measurable intraoperative difficulty after matching. Long-term oncological outcomes require further evaluation.