Colonic Stenting as a Bridge to Surgery Versus Emergency Resection in Left-Sided Malignant Large Bowel Obstruction: A Systematic Review.

Acute left-sided malignant large bowel obstruction represents a high-risk surgical emergency, frequently associated with significant morbidity, the need for stoma formation, and increased perioperative complications. The use of self-expanding metallic stents (SEMS) as a bridge to surgery has gained prominence as it allows decompression of the obstructed bowel, patient stabilisation, and conversion to a planned elective procedure. This systematic review included seven studies (four randomised controlled trials and three observational cohorts; total n = 819) comparing SEMS as a bridge to surgery with emergency resection. Across the evidence included, SEMS was consistently associated with lower rates of stoma formation and improved facilitation of elective surgery, while short-term morbidity and mortality remained comparable between the two approaches. Stent-related complications, including perforation, were relatively uncommon and largely dependent on operator expertise. Long-term oncological outcomes, including overall survival and disease-free survival, were similar between SEMS and emergency surgery groups, suggesting that the use of SEMS does not adversely affect cancer-related outcomes. Functional benefits, such as effective bowel decompression and improved perioperative optimisation, were more evident in the SEMS group, particularly among elderly patients and those with significant comorbidities. Despite variability in study design and outcome reporting, the overall body of evidence supports SEMS as a safe and effective bridge-to-surgery strategy. It offers meaningful short-term clinical advantages without compromising long-term oncological safety in appropriately selected patients with left-sided malignant large bowel obstruction.