Diversion ostomy improves treatment tolerance, conversion surgery, and survival compared with self-expanding metal stenting in initially unresectable obstructive colorectal cancer

Category	Detail
Condition	Obstructive Colorectal Cancer
Key Mechanisms	Comparison of diversion ostomy (DO) and self-expanding metal stent (SEMS) for bowel decompression.
Target Population	Patients with initially non-resectable obstructive colorectal cancer.
Care Setting	Oncology and surgical departments managing colorectal cancer.

DO achieved a higher CROSS score 3 rate than SEMS (85.5% vs. 47.2%; P<0.001).
Median chemotherapy cycles were significantly higher in the DO group (6 vs. 2; P<0.001).
Objective response and resection rates were significantly higher in the DO group (69.4% vs. 30.2%; P<0.001).
DO group had a median overall survival of 27.8 months compared to 10.3 months for SEMS (P<0.0001).
SEMS was independently associated with worse overall survival (hazard ratio 2.231; P = 0.001).

Histologically confirmed colorectal adenocarcinoma.
Radiologically and/or endoscopically confirmed primary tumor-related colonic obstruction.

Initial decompression strategy using either DO or SEMS.
Subsequent systemic therapy based on molecular and immunohistochemical findings.

SEMS may lead to complications such as perforation, migration, and re-obstruction.

Patients with initially non-resectable obstructive colorectal cancer treated between June 2021 and June 2025.

DO is associated with better treatment tolerance and higher resection rates compared to SEMS.

Consider DO for patients requiring bowel decompression prior to systemic therapy.
Multidisciplinary team assessment is crucial for determining resectability.

Clinical Scorecard: Diversion Ostomy Enhances Treatment Tolerance, Surgical Conversion Rates, and Survival Compared to Self-Expanding Metal Stenting in Patients with Initially Non-Resectable Obstructive Colorectal Cancer