Self-expandable metal stents as a bridge to surgery for obstructive colorectal cancer: a propensity score-matched retrospective cohort study

Acute colorectal obstruction constitutes a surgical emergency in patients with colorectal cancer (CRC) and is associated with high morbidity and mortality when managed with emergency surgery. Although self-expandable metal stents (SEMS) may optimize surgical conditions, concerns remain regarding their long-term oncologic safety. This retrospective cohort study included 355 patients with obstructive CRC treated between 2014 and 2023, including 65 patients in the SEMS group and 290 in the surgery-alone group. Perioperative outcomes, postoperative complications, disease-free survival (DFS), and overall survival (OS) were compared. Propensity score matching and multivariate Cox regression were applied to reduce selection bias and adjust for confounding factors. Patients in the SEMS group had a markedly higher rate of laparoscopic surgery (89.2% vs. 62.8%, p < 0.001) as well as a significantly shorter postoperative hospital stay (11.05 ± 5.25 vs. 14.29 ± 11.86 days, p = 0.032). No significant differences were observed in overall postoperative complications, DFS, or OS between the two groups after adjustment. Although a higher crude recurrence rate, particularly intra-abdominal recurrence, was observed in the SEMS group, SEMS placement was not an independent predictor of adverse oncologic outcomes. SEMS as a bridge to surgery was associated with improved perioperative outcomes and showed no statistically significant adverse impact on long-term survival after adjustment for confounding factors. Further prospective studies are required to confirm oncologic safety in selected patients.