SEMS bridge to elective laparoscopic surgery versus emergency surgery for obstructive colorectal cancer: a propensity score-matched retrospective cohort study

Abstract

BACKGROUND: This study compared perioperative recovery and clinical outcomes of patients with obstructive colorectal cancer (OCRC) undergoing self-expandable metallic stent (SEMS) placement followed by elective laparoscopic resection versus emergency surgery. METHODS: Between January 2019 and January 2021, 83 patients were included: 51 underwent SEMS placement followed by elective laparoscopic resection and 32 underwent emergency surgery. Propensity score matching (PSM) yielded 56 patients (28 per group). Operative parameters, gastrointestinal recovery, postoperative complications, oncologic quality indicators, and overall survival (OS) were evaluated. Survival was analyzed using Cox proportional hazards regression. RESULTS: SEMS followed by elective laparoscopic resection was associated with shorter operative time and faster gastrointestinal recovery. Postoperative complications were numerically less frequent in the SEMS group (7.1% vs. 17.9%), although the difference was not significant (p=0.417). Adjusted Cox regression showed higher mortality risk after emergency surgery (HR=2.43, 95% CI 1.04-5.68, p=0.040), although only 16 deaths occurred. Two-year OS was numerically higher with SEMS (82.1% vs. 60.7%), without statistical significance (p=0.076). Conclusions: SEMS as a bridge to elective laparoscopic resection was associated with faster gastrointestinal recovery and fewer postoperative complications. The potential survival benefit warrants confirmation in larger prospective multicenter studies. CONCLUSIONS: SEMS placement as a bridge to elective laparoscopic resection was associated with improved gastrointestinal recovery and a numerically lower complication rate. The potential survival benefit requires confirmation in larger prospective multicenter studies.