Stenting versus Emergency Surgery for Malignant Left-Sided Colonic Obstruction

Abstract

Introduction: Malignant large bowel obstruction is a surgical emergency. Self-expanding metal stents (SEMS) as a bridge to elective surgery have been proposed to avoid emergency stoma formation. This review compares SEMS followed by elective surgery versus emergency resection for left-sided obstructive colon cancer.

Methods: A literature review was conducted including randomized controlled trials and meta-analyses. Outcomes were primary anastomosis rate, permanent stoma rate, 30-day mortality, and long-term recurrence.

Results: Seven randomized trials were analyzed. SEMS increased the rate of primary anastomosis (eighty to ninety percent versus fifty to sixty percent) and reduced permanent stoma rates. However, SEMS was associated with a small but significant increase in long-term local recurrence, possibly due to tumor microperforation. Thirty-day mortality was similar. Technical failure of stenting occurred in five to ten percent.

Discussion: The trade-off between avoiding emergency stoma and a potential increase in recurrence remains unresolved. SEMS may be preferred for patients with high surgical risk or those who need preoperative optimization. For potentially curable patients, the risk of recurrence may favor emergency resection. Clinical perforation during stenting mandates immediate surgery.

Conclusions: SEMS as a bridge to surgery improves primary anastomosis rates but may increase local recurrence. Decision-making should be individualized based on patient risk and oncologic goals.