Patients with malignant large bowel obstruction, a serious presentation of colorectal cancer, often undergo placement of a self-expandable metallic stent to decompress the colon before tumor resection. How long surgeons should wait between stent insertion and surgery has remained uncertain. An updated systematic review and meta-analysis published in BMC Gastroenterology compared postoperative outcomes across three clinically relevant intervals—7 days or fewer, 8 to 14 days, and more than 14 days—and found that the middle window showed the most favorable overall pattern, while stopping short of claiming definitive superiority.

The review was designed and reported according to PRISMA 2020 guidelines. The researchers searched PubMed, Embase, Web of Science Core Collection, SinoMed, and the Cochrane Library from inception to June 30, 2025, with two reviewers independently screening studies and extracting data. Eligible patients had undergone stent placement followed by tumor resection. For single-arm dichotomous outcomes, event proportions were transformed to log odds and pooled using the generic inverse-variance method; intraoperative blood loss was synthesized as a pooled mean. Differences among timing subgroups were assessed with chi-squared tests for subgroup differences. The analysis included 33 studies covering 1,130 patients, and the work was retrospectively registered with PROSPERO under CRD420261474024.

The clearest signal emerged for stoma formation. The pooled odds ratio was 0.09 (95 percent confidence interval 0.06–0.15) in the 8–14-day group, significantly lower than 0.23 (95 percent CI 0.15–0.35) for surgery more than 14 days after stenting (P for subgroup difference = 0.005) and lower than 0.20 (95 percent CI 0.12–0.34) for surgery within 7 days (P = 0.03). A lower odds ratio in this single-arm pooling framework indicates a smaller proportion of patients requiring a stoma, so the intermediate interval was associated with the fewest stomas among the three windows.

The pooled odds ratio was 0.03 (95 percent CI 0.01–0.06) at 8–14 days compared with 0.08 (95 percent CI 0.04–0.16) at more than 14 days, a statistically significant difference (P = 0.03). By contrast, comparing surgery within 7 days against the 8–14-day window showed no significant difference for leakage (P = 0.78), leaving the advantage of the intermediate interval clearest against delayed rather than early operations.

Not every outcome favored one timing strategy. The analysis found no significant subgroup differences for pooled mean intraoperative blood loss, overall postoperative complications, or 30-day mortality, meaning the apparent benefit of the 8–14-day window was confined to stoma rates and anastomotic leakage rather than extending to broader surgical outcomes or survival. The authors also emphasized an important limitation: most of the included evidence was observational, which restricts the strength of causal conclusions that can be drawn about timing.

The authors concluded that surgery performed 8–14 days after stent placement showed the most favorable overall pattern among the evaluated intervals, but that the evidence does not establish definitive superiority over alternative timing strategies. They suggested the 8–14-day interval may be considered a potentially favorable surgical window when clinically appropriate, pending confirmation in prospective comparative studies. For clinicians managing malignant large bowel obstruction, the review offers a synthesized, if imperfect, basis for scheduling decisions, while underscoring that randomized prospective data will be needed before any interval can be declared definitively optimal.

Subject of Research: Optimal timing of surgery after self-expandable metallic stent placement for malignant large bowel obstruction

Article Title: The impact of the optimal timing for surgery after stent placement in patients with malignant large bowel obstruction (MLBO) on postoperative clinical outcomes-update 2025: a systematic review and meta-analysis

Article References: Li, L., Huang, J., Wang, L., Wu, Z., Chen, J., Shan, Y., Lin, K., & Cheng, K. (2026). The impact of the optimal timing for surgery after stent placement in patients with malignant large bowel obstruction (MLBO) on postoperative clinical outcomes-update 2025: a systematic review and meta-analysis. BMC Gastroenterology. https://doi.org/10.1186/s12876-026-05468-z

Image Credits: AI Generated

DOI: 10.1186/s12876-026-05468-z

Keywords: malignant large bowel obstruction, colorectal cancer, self-expandable metallic stent, stent-to-surgery interval, systematic review, meta-analysis, anastomotic leakage, stoma formation, postoperative complications, BMC Gastroenterology, impact, optimal