Background/Objectives: Colon cancer presents as an obstruction in almost 30% of patients. Self-expandable metallic stents emerged as an alternative to emergency surgery, despite early controversies around their use. Improved techniques led to stent incorporation in clinical guidelines. Our objective is to compare colectomies performed after the insertion of self-expandable metallic stents versus emergency surgeries in pT4 obstructive left colon cancer, analysing postoperative and oncological outcomes. Methods: This is an observational retrospective multicentre study involving 50 hospitals and analysing data from patients with pT4 obstructive tumours treated for curative intent between 2015 and 2017. Patients with left-sided obstructive colon cancer were included, with exclusion criteria being palliative surgery or incomplete resection. Primary outcomes were local, peritoneal, and systemic recurrence rates, overall survival (OS), and disease-free survival (DFS). Secondary outcomes were postoperative complications and the rate of surgeries without major complications. Results: In total, 196 patients were analysed, 128 undergoing emergency surgery and 68 receiving colonic stents. Stents more frequently allowed for minimally invasive surgeries: 33.8% vs. 4.7% (p< 0.01). The stent group showed fewer major complications (Clavien–Dindo ≥ 3) at 4.5% vs. 22.4% (p< 0.01), fewer infectious complications at 13.2% vs. 23.1% (p= 0.1), and fewer organ-space infections at 3.3% vs. 15.9% (p= 0.03). No significant differences in recurrence rates, 29.4% vs. 28.1% (p= 0.8); disease-free survival, 44.5 vs. 44.3 months (p= 0.5); or overall survival, 50.5 vs. 47.6 months (p= 0.4), were found between groups. Conclusions: Self-expandable metallic stents are a safe alternative for pT4 obstructive left colon cancer, improving postoperative outcomes without compromising short- and medium-term oncological results. Consideration of experienced clinicians and potential referral to centres with advanced stenting capabilities may enhance patient care.
背景/目的：约30%的结肠癌患者表现为梗阻。尽管早期存在争议，自膨式金属支架已成为急诊手术的替代方案。随着技术改进，支架置入术已被纳入临床指南。本研究旨在比较自膨式金属支架置入后结肠切除术与急诊手术治疗pT4期梗阻性左半结肠癌的术后及肿瘤学结局。方法：这项观察性回顾性多中心研究涵盖50家医院，分析了2015年至2017年间以根治为目的治疗的pT4期梗阻性肿瘤患者数据。纳入左半结肠梗阻性癌患者，排除姑息手术或切除不完整病例。主要结局指标为局部、腹膜及全身复发率、总生存期（OS）和无病生存期（DFS）。次要结局指标包括术后并发症及无严重并发症手术率。结果：共分析196例患者，其中128例接受急诊手术，68例接受结肠支架治疗。支架组更常实施微创手术（33.8% vs. 4.7%，p<0.01）。支架组严重并发症（Clavien-Dindo≥3级）发生率更低（4.5% vs. 22.4%，p<0.01），感染性并发症更少（13.2% vs. 23.1%，p=0.1），器官间隙感染率更低（3.3% vs. 15.9%，p=0.03）。两组在复发率（29.4% vs. 28.1%，p=0.8）、无病生存期（44.5 vs. 44.3个月，p=0.5）及总生存期（50.5 vs. 47.6个月，p=0.4）方面均无显著差异。结论：自膨式金属支架是治疗pT4期梗阻性左半结肠癌的安全替代方案，可改善术后结局且不影响中短期肿瘤学疗效。建议由经验丰富的临床医师评估，并考虑转诊至具备先进支架置入技术的医疗中心，以提升患者诊疗水平。
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