Colorectal cancer (CRC) is a leading cause of cancer mortality, with many patients presenting with malignant colorectal obstruction (MCO). Self-expandable metal stents (SEMSs) have emerged as a minimally invasive key intervention, both as a bridge to surgery (BTS) in curative setting sand for palliation in advanced disease. This review aims to provide an evidence-based analysis of SEMS indications, contraindications, and efficacy across curative and palliative contexts, with focus on long-term outcomes. Based on data from recent trials and guidelines, we examine SEMS placement outcomes, focusing on specific scenarios, including BTS for left-sided MCO, chemotherapy (with angiogenic agents) safety during stent therapy, the optimal timing between SEMS placement and surgery, and oncological outcomes. We also discuss the use of SEMSs in challenging contexts such as proximal colon obstruction and extracolonic obstruction, and the relevant technical considerations. Findings indicate that using a SEMS in the BTS setting reduces emergency surgery needs, minimizes complications, and decreases stoma formation. Long-term oncologic outcomes, particularly recurrence, are still debated, but recent evidence shows that SEMS placement is safe, without worsening long term outcomes. Palliative SEMS placement shows high efficacy in symptom relief with manageable adverse events. Success depends on patient selection and technical expertise, with multidisciplinary approaches essential for optimal outcomes.
结直肠癌（CRC）是癌症死亡的主要原因，许多患者表现为恶性结直肠梗阻（MCO）。自膨式金属支架（SEMS）已成为一种微创关键干预手段，既可作为根治性治疗中手术的过渡桥梁（BTS），也可用于晚期疾病的姑息治疗。本综述旨在基于证据分析SEMS在根治与姑息治疗中的适应证、禁忌证及疗效，重点关注长期结局。基于近期临床试验及指南数据，我们研究了SEMS置入的结局，聚焦于特定临床场景，包括左侧MCO的BTS治疗、支架治疗期间联合化疗（尤其抗血管生成药物）的安全性、SEMS置入与手术的最佳时机以及肿瘤学结局。同时探讨了SEMS在近端结肠梗阻和结肠外梗阻等复杂情况下的应用及相关技术考量。研究结果表明，在BTS场景中使用SEMS可减少急诊手术需求、降低并发症并减少造口形成。长期肿瘤学结局（特别是复发率）仍存争议，但最新证据显示SEMS置入安全且不会恶化长期预后。姑息性SEMS置入在缓解症状方面疗效显著，不良事件可控。治疗成功取决于患者选择和技术专长，多学科协作对实现最佳结局至关重要。
肿瘤(癌症)患者之家