Is there a preferred management option for malignant large bowel obstruction secondary to colorectal cancer: A systematic review and meta-analysis between colonic stents as a bridge to surgery versus emergency surgery?

To compare peri-operative and oncological outcomes between self-expanding metal stents as a bridge-to-surgery (SEM-BTS) and emergency surgery for malignant large bowel obstruction (MLBO) secondary to colorectal cancer. This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD420251114887). A comprehensive search of PubMed, OVID Medline and Embase identified English-language studies from January 2000 to June 2025. Both randomised and observational comparative studies were included. Outcomes analysed included rates of primary anastomosis, stoma formation, peri-operative complications and long-term oncological endpoints. Twenty-four studies (N = 3449; 7 RCTs and 17 observational) met inclusion criteria. SEM-BTS was associated with higher rates of primary anastomosis (OR 2.81, 95% CI 1.98-3.99), lower stoma formation (OR 0.29, 95% CI 0.20-0.41) and greater use of laparoscopic surgery (OR 5.13, 95% CI 1.67-15.79). There were no significant differences in anastomotic leak, post-operative mortality, recurrence or 5-year overall survival. SEM-BTS provides superior short-term surgical outcomes without compromising oncological safety when applied in appropriately selected patients with centres with experienced endoscopists. While stent-related complications remain a concern, SEM-BTS may be considered a viable alternative to emergency surgery for left-sided MLBO.