Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2025; 17(7): 104118
Published online Jul 27, 2025. doi: 10.4240/wjgs.v17.i7.104118
Outcomes of colonic stent as a bridge to surgery vs emergency surgery for acute obstructive left-sided colon cancer
Hui Xiao, Hua-Chong Ma
Hui Xiao, Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
Hua-Chong Ma, Department of Acute Abdominal Surgery, Capital Medical University, Beijing 100020, China
Author contributions: Xiao H contributed to the writing and editing of the manuscript, literature search, and discussion and design of the manuscript; Ma HC designed the overall concept and outline of the manuscript.
Institutional review board statement: The study was approved by the Ethics Committee of the Beijing Chaoyang Hospital.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hua-Chong Ma, MD, PhD, Professor, Department of Acute Abdominal Surgery, Capital Medical University, No. 8 Gongti South Road, Beijing 100020, China. xh1988@foxmail.com
Received: December 12, 2024
Revised: March 26, 2025
Accepted: May 20, 2025
Published online: July 27, 2025
Processing time: 225 Days and 4.1 Hours
Abstract
BACKGROUND

Self-expandable metal stent (SEMS) as a bridge to surgery (BTS) has become a popular alternative to emergency surgery in the management of acute left-sided malignant colonic obstruction (MCO). However, it remains controversial for colonic stent as a BTS due to a lack of consensus and insufficient data.

AIM

To assess the clinical and oncological safety of SEMS insertion followed by elective resection for acute left-sided MCO.

METHODS

The data from 96 patients with acute left-sided MCO in our institution from January 2018 to May 2020 were analyzed retrospectively. They underwent colonic stenting as a bridge to elective surgery (BTS group: n = 40) or emergency resection (ER group: n = 56). Demographic characteristics, stoma rate, laparoscopy rate, postoperative complications, and oncological outcomes were compared between the two groups.

RESULTS

The two groups were comparable with regard to the demographics and tumor characteristics. The stoma rate was 7.5% in the BTS group vs 48.2% in the ER group (P < 0.05). Primary anastomosis was performed in all patients in the BTS group, and only three patients underwent protective stoma in the BTS group. The BTS group had a significantly higher rate of laparoscopic surgery than the ER group (90% vs 57.1%, P < 0.05), and the major postoperative complication rate was significantly higher in the ER group than in the BTS group (33.9% vs 15%, P = 0.04). According to the Kaplan-Meier survival analysis and log rank test, no significant differences existed in the two groups with regard to the overall survival and disease-free survival.

CONCLUSION

The utilization of SEMS as a BTS is a useful alternative to emergency surgery in the treatment of acute left-sided MCO. SEMS insertion as a BTS can provide an effective and safe therapeutic option compared to emergency surgery.

Keywords: Self-expandable metal stents; Bridge to surgery; Emergency surgery; Acute left-sided malignant colonic obstruction; Malignant colonic obstruction

Core Tip: Enrolling a total of 96 patient, this study demonstrated that the utilization of self-expandable metal stent as a bridge to surgery seems to be a useful alternative to emergency surgery in the management of acute left-sided malignant colonic obstruction. Self-expandable metal stent insertion as a bridge to surgery can provide an effective and safe therapeutic option compared to emergency surgery. The current focus of this field is on acute left-sided malignant colonic obstruction, oncological prognosis, and perioperative management.