Objective:

To compare the clinical outcomes of diversion ostomy (DO) and self-expanding metal stent (SEMS) placement in patients with initially non-resectable obstructive colorectal cancer undergoing conversion intent treatment.

Approach:

• Patient Selection: Retrospective review of 115 patients treated between June 2021 and June 2025, with 62 undergoing DO and 53 undergoing SEMS as initial decompression strategies.
• Treatment Protocol: Post-decompression, patients received CAPEOX or FOLFOX-based systemic therapy with targeted therapy, with or without immunotherapy.

Key Findings:

• DO was associated with a significantly higher rate of achievement of Colorectal Obstruction Scoring System (CROSS) score 3 than SEMS (85.5% vs. 47.2%; P<0.001).
• Patients in the DO group received a median of 6 chemotherapy cycles versus 2 in the SEMS group (P<0.001).
• Post-treatment nutritional and inflammatory profiles were more favorable in the DO group, with higher Prognostic Nutritional Index (≥45) rates and lower platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios (all P ≤ 0.005).
• The objective response and subsequent resection rates were significantly higher in the DO group than that in the SEMS group (69.4% vs. 30.2%; P<0.001).
• Kaplan–Meier analysis revealed significantly longer overall survival in the DO group, with a median survival of 27.8 vs. 10.3 months (P<0.0001).

Interpretation:

DO is associated with better decompression, improved treatment tolerance, higher resection rates, and longer survival compared to SEMS in patients with initially non-resectable obstructive colorectal cancer.

Limitations:

• The study is retrospective and may be subject to selection bias.
• Data was collected from a single institution, which may limit generalizability.

Conclusion:

DO is superior to SEMS in enhancing treatment outcomes for patients with initially non-resectable obstructive colorectal cancer.