Neoadjuvant chemotherapy as a bridge to surgery versus direct surgery following SEMS placement in obstructive left-sided colon cancer: a multicenter prospective cohort study
In brief
After colon stenting, chemotherapy group had 66% five-year survival
In a matched cohort of patients with obstructing left-sided colon cancer, those given chemotherapy before surgery had higher five-year overall survival than those having surgery alone after stenting: 66% versus 52%. Five-year disease-free survival was also higher, 65% versus 40%, with similar stent-related complication rates; the prospective observational study cannot prove chemotherapy caused the survival differences.
- Journal
- British journal of cancer (Q1)
- Published
- 29 September 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Yang Shi, Zhi Wei Zhai, Ke Cao, Chun Xiang Ye, Yan Sen Li, Yan Lei Wang, et al.
- PMID
- 42811046
- DOI
- 10.1038/s41416-026-03623-7
Why clinicians should know about it
- Picked for Surgery (paper of the day, 3 October 2026): SEMS + neoadjuvant chemo for obstructive left colon cancer
Abstract
OBJECTIVE: To investigate the perioperative complications and long-term outcomes of self-expanding metallic stent (SEMS) placement combined with neoadjuvant chemotherapy followed by elective surgery in patients with complete obstructive left-sided colon cancer (COLCC). METHODS: A multicenter prospective study enrolled 246 COLCC patients, comparing SEMS-surgery (n = 105) and SEMS-neoadjuvant-surgery (n = 141). 1:1 propensity score matching (PSM) and 8-week landmark analyses were used to mitigate biases. Primary outcomes included SEMS-related complications, overall survival (OS), and disease-free survival (DFS). RESULTS: In the PSM cohort (n = 206), SEMS-related complication rates were similar between the neoadjuvant and surgery-alone groups (15.5% vs. 14.6%, P = 0.845). The SEMS-neoadjuvant-surgery group demonstrated superior 5-year OS (66.2% vs. 51.7%, P < 0.001) and 5-year DFS (65.3% vs. 40.0%, P < 0.001). Landmark analysis consistently validated these survival benefits. Multivariable Cox regression confirmed neoadjuvant chemotherapy as an independent protective factor for both OS (HR = 0.436, 95% CI: 0.188-0.996, P = 0.015) and DFS (HR = 0.661, 95% CI: 0.551-0.830, P = 0.002). CONCLUSION: The SEMS-neoadjuvant-surgery strategy is associated with superior long-term survival without increasing SEMS-related complications, strongly supporting its clinical feasibility and oncological safety for COLCC.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.