Management of Malignant Left-Side Colonic Obstruction Using Self-Expandable Metal Stents as a Bridge to Elective...

Colonic obstruction is a life-threatening condition, requiring emergency surgery (ES) that usually implies laparotomy and stoma construction. Self-expandable metal stents (SEMS) can be used to overcome the occlusion, realizing the so-called "bridge to surgery (BTS)", allowing management of the patient in an elective setting.

We present a case of a 59-year-old man with left colonic obstruction related to stenosing colorectal cancer (CRC) successfully treated with SEMS placement and early laparoscopic definitive surgery. The patient had an excellent course with no stenting or surgery-related complications. Probably young age, no comorbidity and endoscopic expertise played a main role in this favourable outcome, at least in the short term.

Our critical review of the literature published over a period spanning more than two decades, encompassing 41 studies, indicates that SEMS used as a BTS in patients with malignant colorectal obstruction is associated with improved short-term outcomes compared to ES. Specifically, SEMS placement has been shown to reduce postoperative morbidity, lower stoma formation rates, and facilitate preoperative optimization in selected patients. Nevertheless, concerns remain regarding potential adverse oncological outcomes, particularly in terms of local recurrence and disease-free survival. These concerns are compounded by the heterogeneity of available studies, which are predominantly retrospective and underpowered, and by the scarcity of large-scale randomized controlled trials (RCTs). Furthermore, the limited dissemination of technical expertise and institutional experience in SEMS placement continues to restrict its widespread implementation in clinical practice.

The clinical success of SEMS placement as a BTS strategy is contingent upon rigorous patient selection, coordinated multidisciplinary team involvement, and the availability of experienced endoscopists and surgical teams. When these prerequisites are met, SEMS offers an effective means of converting an acute surgical emergency into an elective procedure, thereby mitigating perioperative risk and improving patient-centered outcomes. However, the lack of robust long-term oncological data and the limited penetration of stenting expertise across healthcare institutions remain major impediments to broader adoption. Continued efforts to generate high-quality evidence and promote structured training programs are essential to fully define the role of SEMS in the management of malignant bowel obstruction.