To compare the efficacy of sequential neoadjuvant therapy following self-expanding metal stent (SEMS) placement versus laparoscopic surgery alone in obstructive colorectal cancer (OCRC).

A retrospective cohort study with propensity score matching (PSM) was conducted. Clinical data of 157 patients with OCRC who underwent SEMS placement at Tangdu Hospital, Air Force Medical University from February 2018 to October 2024 were collected. Patients were divided into a bridging laparoscopic surgery group (bridging group) and a sequential neoadjuvant therapy plus laparoscopic surgery group (sequential group) according to subsequent treatment strategies. After 1:2 PSM, a total of 60 patients were included, with 20 in the bridging group and 40 in the sequential group. Perioperative outcomes, tumor pathological characteristics, and survival outcomes were compared between the two groups.

The interval from stent placement to surgery was significantly longer in the sequential group (t=8.22, P＜0.05), but the postoperative hospital stay was significantly shorter (t=3.15, P＜0.05). Regarding safety and feasibility, the proportion of patients with moderate surgical risk (ASA class III) was slightly lower in the sequential group (7.5% vs. 20.0%, Z=−1.81, P＞0.05), and the rate of primary stoma creation was also lower (7.5% vs. 20.0%, χ²=0.99, P＞0.05). The two groups were comparable in terms of operative time, R0 resection rate, intraoperative blood transfusion rate, quality of surgical specimens (CME or TSME), time to first postoperative flatus, and overall incidence of postoperative complications. In terms of oncological outcomes, there was a statistically significant difference in postoperative pathological TNM staging between the two groups (Z=−2.10, P＜0.05), with a pathological complete response rate of 12.5% in the sequential group. The tumor diameter was slightly smaller in the sequential group (Z=−1.17, P＞0.05). The sequential group had a higher number of harvested lymph nodes and fewer positive lymph nodes, as well as a lower positive lymph node ratio compared to the bridging group, although these differences were not statistically significant (all P＞0.05). The disease-free survival rate was significantly better in the sequential group (χ²=4.13, P＜0.05). Although the difference in overall survival rate was not statistically significant (χ²=1.31, P＞0.05), a superior trend was observed in the sequential group.

Sequential neoadjuvant therapy following SEMS placement and laparoscopic surgery is safe and feasible for OCRC patients, facilitating postoperative recovery and improving disease-free survival.