MALIGNANT LEFT-SIDED COLONIC OBSTRUCTION: SELF-EXPANDING METAL STENT AS A BRIDGE TO SURGERY VERSUS EMERGENCY SURGERY
Keywords:
malignant bowel obstruction; colorectal cancer; colonic stent; SEMS; emergency surgery; bridge to surgery; systematic reviewAbstract
DOI: https://doi.org/10.46296/yc.v10i19.0996
Abstract
Introduction: Acute malignant obstruction of the left colon is an oncological emergency associated with high morbidity, the risk of ostomy, and the need for rapid therapeutic decisions. The use of a self-expanding metal stent (SEMS) as a bridge to surgery allows for endoscopic decompression and delayed resection, although concerns regarding perforation and oncological safety persist. Objective: To compare the effectiveness and safety of SEMS as a bridge to surgery versus emergency surgery in adults with potentially resectable malignant left-sided colonic obstruction. Methods: A systematic review updated in accordance with PRISMA 2020 guidelines. The systematic review and network meta-analysis by McHugh et al. (search up to August 2023; 5,225 records) served as the baseline search, with the synthesis restricted to direct comparisons between SEMS and emergency resection. A targeted update was conducted covering the period from January 2024 to April 30, 2026, using PubMed/PMC, Google Scholar, and SciELO, alongside reference tracking, prioritizing publications with accessible full text. Outcomes evaluated included mortality, morbidity, ostomy rates, primary anastomosis, minimally invasive approaches, perforation, and oncological results. Results: Comparative evidence favors SEMS regarding short-term surgical outcomes: lower overall morbidity, lower rates of permanent ostomy, and a higher likelihood of primary anastomosis and minimally invasive surgery. Randomized trials do not show a consistent reduction in mortality. Contemporary analyses reveal no clear differences in overall or disease-free survival, although stent-related perforation remains a significant oncological concern. Conclusions: In centers with endoscopic expertise, SEMS as a bridge to surgery is a valid alternative to emergency surgery for selected patients with malignant left-sided obstruction without perforation. Its primary benefit lies in reducing the immediate surgical burden and the need for an ostomy.
Keywords: malignant bowel obstruction; colorectal cancer; colonic stent; SEMS; emergency surgery; bridge to surgery; systematic review.
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