Abstract / Summary
Abstract Background: Malignant left-sided colonic obstruction is a high-risk presentation of colorectal cancer. Although self-expandable metal stenting may convert emergency surgery into elective resection, local outcomes remain limited. This study evaluated short-term procedural, surgical, postoperative, pathological, and early follow-up outcomes after colonic stenting as a bridge to curative-intent surgery.
Methods: We conducted a single-center retrospective cohort study at King Fahad Medical City, Riyadh, Saudi Arabia, from 2013 to 2025. Adults with non-metastatic left-sided malignant large-bowel obstruction who underwent stenting followed by curative-intent resection were included. Outcomes were summarized descriptively. Exact binomial 95% CIs were calculated for key proportions. Exploratory analyses assessed outcomes by stent-to-surgery interval.
Results: Among the 20 included patients, the median age was 51 years, 55.0% were women, and 70.0% had sigmoid tumors. Technical and clinical success were achieved in 100.0% of the included cohort. Stent perforation occurred in 5.0% of the cases, and no migration was recorded. The median time from stenting to surgery was 15.5 days. Stoma-free primary anastomosis was achieved in 95.0% of the cases, and minimally invasive surgery was performed in 85.0% of the cases. Any 30-day complication occurred in 75.0%, but major morbidity and anastomotic leak each occurred in 5.0%. No surgical site infections or 30-day mortalities were recorded. All patients achieved R0 resection, with a median lymph node harvest of 18. Systemic chemotherapy was received by 90.0%. Over a median follow-up of 22.6 months, 85.0% were alive, and no documented recurrence was identified.
Conclusion: In this selected single-center cohort, bridge-to-surgery colonic stenting was associated with high procedural success, frequent stoma-free primary anastomosis, and favorable short-term surgical and pathological outcomes. Larger prospective studies should include all attempted stenting procedures, emergency surgery controls, patient-reported stoma outcomes, and long-term oncologic endpoints.