A bridge-to-surgery approach using colonic stent placement offers similar short-term survival outcomes to emergency surgery in patients with left-sided obstructive colorectal cancer, while reducing the need for stomas and enabling more minimally invasive procedures, according to new research.
Bowel obstruction is a common emergency presentation in colorectal cancer, and the optimal management strategy remains debated. Emergency resection has traditionally been the standard approach, but self-expanding metal stents are increasingly used to relieve obstruction and allow time for patient optimisation before elective surgery. Ongoing concerns around oncological safety, however, have limited wider uptake.
Comparing Stent Placement With Emergency Resection
In this retrospective study, investigators analysed outcomes in 65 consecutive patients presenting with left-sided obstructive colorectal cancer. Patients were managed either with emergency surgical resection or with colonic stent placement followed by planned surgery.
The two groups were compared for postoperative complications, serious adverse events, postoperative mortality, three-year disease-free survival, and three-year overall survival. This design allowed assessment of both perioperative safety and short-term oncological outcomes.
Similar Survival Outcomes, Fewer Stomas
The results showed no significant differences between the two approaches in postoperative complications, serious complications, or postoperative mortality. Importantly, oncological outcomes were also comparable, with no statistically significant differences in three-year disease-free survival or overall survival between the stent and emergency surgery groups.
However, procedural advantages were observed in the stent group. Patients treated with a bridge-to-surgery strategy required significantly fewer end colostomies and were more likely to undergo minimally invasive surgery. These factors may translate into improved postoperative recovery and quality of life.
Implications for Clinical Practice
The findings suggest that colonic stent placement as a bridge to surgery is a valuable option for selected patients with obstructive colorectal cancer. By reducing stoma formation and facilitating minimally invasive surgical approaches without compromising short-term oncological outcomes, this strategy may offer meaningful benefits for patients.
The authors note that further prospective studies are needed to confirm long-term survival outcomes and to better define which patients are most likely to benefit from a bridge-to-surgery approach.
Reference
Kesgin YM et al. Effect of stent placement on short term survival of left sided obstructive colorectal cancer: comparison of bridge-to-surgery versus emergency surgery approaches. BMC Gastroenterol. 2025;DOI: 10.1186/s12876-025-04505-7.
