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Background <p>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.</p> Methods <p>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).</p> Results <p>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&#xa0;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; <i>p</i> = 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%; <i>p</i> = 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.</p> Conclusions <p>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.</p>

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

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  • 发表日期：

    2026年6月3日

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  • Alessio Giordano,
  • Manuela Mastronardi,
  • Paola Fugazzola,
  • Giulia Montori,
  • Ferdinando Agresta,
  • Jacopo Martellucci,
  • Fausto Catena,
  • Federico Coccolini,
  • Gabriele Anania,
  • Gianluca Costa,
  • Vincenzo Bottino,
  • Nicola Cillara,
  • Paolo Prosperi,
  • Carlo Bergamini,
  • Mauro Podda,
  • Marco Scatizzi,
  • Luigi Ricciardielli,
  • Diego Cuccurullo,
  • Mario Guerrieri,
  • Alberto Sartori,
  • Massimo Sartelli,
  • Luca Ansaloni,
  • Nereo Vettoretto,
  • Monica Ortenzi,
  • Emanuele Botteri,
  • Jacopo Martellucci,
  • Mauro Marzano,
  • Biagio Casagranda,
  • Silvia Palmisano,
  • Alan Biloslavo,
  • Letizia Cecchini,
  • Nicolò de Manzini,
  • Pietro Fransvea,
  • Silvia Tedesco,
  • Caterina Puccioni,
  • Ruggero Bollino,
  • Massimiliano Casadei,
  • Denise Marchesini,
  • Mauro Podda,
  • Lisa Seu,
  • Federica Frongia,
  • Anna Guariniello,
  • Nicola Albertini,
  • Claudia Di Leo,
  • Andrea Borasi,
  • Andrea Barberis,
  • Francesco Ghiglione,
  • Michele Tarricone,
  • Maddalena De Capua,
  • Mauro Ghirardi,
  • Leo Licari,
  • Gianluca Gambino,
  • Vincenzo Sorce,
  • Andrea Celotti,
  • Martina Bonafede,
  • Luca Mattia Quarti,
  • Marco Clementi,
  • Danilo Meloni,
  • Irene Tucceri Cimini,
  • Giorgio Ammerata,
  • Michele Mazza,
  • Giuseppe Sena,
  • Giuseppe Palomba,
  • Giovanni Aprea,
  • Ciro de Martino,
  • Giuseppe Miranda,
  • Enrico Erdas,
  • Gian Luigi Canu,
  • Federico Cappellacci,
  • Manish Kumar Agrawal,
  • Akshay Anand Abhinav,
  • Arun Sonkar,
  • Amit Gupta,
  • Deepak Rajput,
  • Avijit Mondal,
  • Jacopo Andreuccetti,
  • Giusto Pignata,
  • Claudia Zaghi,
  • Franco Poli,
  • Houshang Kalamian,
  • Marco Milone,
  • Anna D’amore,
  • Giovanni De Palma,
  • Giuseppe Curro,
  • Michele Ammendola,
  • Silvia Curcio,
  • Andrea-Pierre Luzzi,
  • Salvatore Carrabetta,
  • Raquel Diaz,
  • Valerio Caracino,
  • Paola Salusso,
  • Diletta Frazzini,
  • Paolo Di Mattia,
  • Chiara Toscano,
  • Debora Maria Di Dio,
  • Valeria Tonini,
  • Lodovico Sartarelli,
  • Maurizio Cervellera,
  • Giuseppe Evola,
  • Luigi Piazza,
  • Lorenzo Ripamonti,
  • Nicolò Tamini,
  • Giulia De Carlo,
  • Francesco Feroci,
  • Carla Vaccaro,
  • Benedetta Pesi,
  • Antonello Mirabella,
  • Stefano Mandalà,
  • Dario Iadicola,
  • Pasquale Cianci,
  • Ivana Conversano,
  • Fabio Curci,
  • Paolo Ialongo,
  • Pisicchio Simona,
  • Rrozhani Valentina,
  • Angelo Benevento,
  • Maria Francesca Chiappetta,
  • Federica Galli,
  • Luigi Boccia,
  • Giacomo Brentegani,
  • Roberto Dusi,
  • Raffaele Galleano,
  • Omar Ghazouani,
  • Elena Gambino,
  • Massimo Calistri,
  • Claudia Paolini,
  • Luca Domenico Bonomo,
  • Chiara Marafante,
  • Antonella Nicotera,
  • Paolo Pietro Bianchi,
  • Giampaolo Formisano,
  • Adelona Salaj,
  • Fabio Staderini,
  • Laura Fortuna,
  • Damiano Bisogni,
  • Rita Laforgia,
  • Angela Pezzolla,
  • Pierluigi Lobascio,
  • Andrea Coratti,
  • Giuseppe Giuliani,
  • Francesco Guerra,
  • Michele Marini,
  • Costanzo Antonio,
  • Michela Caprioli,
  • Christian Cotsoglou,
  • Beatrice Torre,
  • Stefano Granieri

摘要

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.