Colonic resection or self-expanding metal stents for obstructive left colon cancer: results of a national multicenter prospective cohort study (CROSCO-1)

Background The optimal management of acute left-sided malignant colonic obstruction remains controversial. Emergency surgery (ES) is associated with substantial morbidity and high stoma rates, whereas self-expanding metal stents (SEMS) as a bridge to surgery (BtS) may convert an emergency into an elective setting. This study aimed to compare the safety, efficacy, and quality-of-life outcomes of ES versus SEMS/BtS. Methods CROSCO-1 is a national, multicenter, prospective observational cohort study conducted in Italy (ClinicalTrials.gov NCT05801211). Consecutive adults with obstructive, non-metastatic left-sided colon cancer (June 2023–October 2024) were included. Patients underwent ES or SEMS followed by elective resection. The primary endpoint was 1-year stoma rate. Secondary outcomes included morbidity, mortality, length of stay, time to chemotherapy, readmissions, oncologic outcomes, and 1-year quality of life (EQ-5D-5L). Results A total of 216 patients were analyzed (ES 144; SEMS/BtS 72). One-year follow-up for the primary outcome was available for 134 ESG and 70 SEMS/BtS patients. SEMS failure occurred in 8.3%. Major morbidity and mortality at 30 and 90 days were similar. The 1-year stoma rate was significantly lower after SEMS/BtS (44.4 vs 73.4%). SEMS/BtS reduced the risk of stoma persistence (adjusted OR 3.74 for ES; p = 0.016). SEMS/BtS was associated with fewer 30-day readmissions (4.2 vs 15.9%) and earlier chemotherapy initiation (76.1 vs 55.8%; p = 0.003). One-year oncologic outcomes were comparable, although limited by short follow-up. Quality of life was significantly better in the SEMS/BtS group. Conclusions In selected patients, SEMS as a bridge to surgery is associated with lower 1-year stoma rates and improved quality of life without increasing short-term morbidity. These findings support a tailored, multidisciplinary approach in experienced centers.